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INTELLECTUAL AND DEVELOPMENTAL TOOL KIT DISABILITIES iowahealthieststate.com/5210

1 GREETINGS!

are youready 5-2-1-0 I/DD Toolkit Revision Team Thank you for taking? the time to review the 5-2-1-0 Healthy Choices Count! IAAP-Iowa Chapter of the American Toolkit for Children with Intellectual and Developmental Disabilities. Academy of Pediatrics- This toolkit was developed by Let's Go! at the Barbara Bush Children's Hospital Committee on Obesity at Maine Medical Center. The Iowa Chapter of the American Academy of AEA-Heartland AEA Pediatrics (IAAP) received the Inclusive Health Grant, sponsored by the AAP ASK Resource Institute for Healthy Childhood Weight with support from Special Olympics to Blank Children's Hospital assemble a group of statewide stakeholders to review and revise the toolkit for Child Health Specialty Clinics use in Iowa. ChildServe Courage League Sports 5-2-1-0 Healthy Choices Count! encourages schools, child care programs, out-of- Harkin Institute school programs, and health care practices to increase healthy eating and Healthiest State Initiative (HSI) physical activity opportunities for ALL children. The program is based on the Iowa Department of Education following easy-to-remember message: Iowa Department of Public Health Iowa Medical Society Look Cook and Eat Special Olympics Iowa University of Iowa Center for Disabilities and Development United Way of Central Iowa The Iowa 5-2-1-0 Intellectual and Developmental Disability Toolkit Revision Team, which includes IAAP and the group of stakeholders listed to the left, believe that children with intellectual and developmental disabilities (I/DD) deserve the same opportunities to lead healthy lives as those offered to typically developing Adapted from the MaineHealth Let's Go! children. While children with I/DD face many of the same challenges to being Intellectual and Developmental Disabilities healthy as their peers, they also experience unique risk factors and additional Toolkit challenges that increase their risk for obesity.

Special thanks to Ingrid Williams, HSI In response to these challenges, 5-2-1-0 I/DD Project Team has revised this toolkit Intern, who was instrumental to the success for professionals like you who work with children with I/DD. Inside you'll find of this project strategies, tools, and resources that address the healthy eating and physical activity needs of children with I/DD. These materials complement the core 5-2-1-0 message and evidence-based strategies for success, and are designed to ensure that the 5-2-1-0 Healthy Choices Count! program can work for each and every child.

Our hope is that this toolkit will not only raise your awareness of the needs of children with I/DD, but also the expectation that, given more support, they can indeed lead healthy, active lives. iowahealthieststate.com/5210 5-2-1-0 Intellectual and Developmental Disabilities Toolkit RevisionTeam 301 Grand Avenue Des Moines, Iowa 50309 www.iowahealthieststate.com/5210 2 T able of onten

CONTENTS

Getting Started Physical Activity • 5-2-1-0 Healthy Choices Count! in Iowa • How to Make Physical Activity Inclusive for • Scientific Rationale for the 5-2-1-0 Message Children with I/DD • 5-2-1-0 Healthy Choices Count! Definitions for • Legal Requirements for Including Children with Children with I/DD I/DD in Physical Activity • Healthy Habit Challenges for Children with I/DD • Tips to Adapt Physical Activities to Include • Healthy Habit Challenges for Children with Children with I/DD Specific Disabilities • Overcoming Barriers to Including Children with • Health Care Challenges for Children with I/DD I/DD in Physical Activity • Services for Children with I/DD • Social Inclusion and Physical Activity • Coordinate Services to Support Healthy Outcomes • Zones, Stations, and Relays for Children with I/DD • T ry Structured Recess! • Tips for Communicating with Children with I/DD • Principles of LET US Play • Use Education and Service Plans to Support • Everyone Plays a Role in Making Physical Healthy Habit Goals for Children with I/DD Activity Inclusive for Children with I/DD • Use Transition Plans to Support Healthy Habits for Teens and Young Adults with I/DD Health Care Healthy Eating • How to Advocate Healthy Habits for Patients with I/DD • How to Promote Healthy Eating for Children • Recommend Healthy Habit Goals for Education with I/DD and Service Plans for Patients with I/DD • When is “Choosy” Eating a Problem? • Health Care Provider Statement Recommending • Oral-Motor and Sensory Problems Healthy Habit Goals • Healthy Foods by Texture • Sample Health Care Provider Statement • T ools to Address Eating Problems in Children Recommending Healthy Habit Goals with I/DD • Make Referrals for Services to Support Healthy • Ideas for Healthy Snacks Habits for Patients with I/DD • Handling a “Choosy” Eater • Everyone Plays a Role in Promoting Healthy Eating for Children with I/DD Non-Food Rewards • How to Provide Non-Food Rewards for Children with I/DD it's All • Why Prohibit the Use of Food as a Reward? • Food Rewards Tracker • Preference Assessments for Children with I/DD about healthy! • Use Non-Food Rewards • Use Physical Activity as a Reward • T ransitioning to Non-Food Rewards for Children with I/DD • Everyone Plays a Role in Providing Non-Food Rewards for Children with I/DD

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it's ALL about healthy! Health Care

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TED STAR GETTING GETTING 5-2-1-0 Healthy Choices Count!

IN IOWA iowahealthieststate.com/5210

Have you ever 5-2-1-0 Healthy Choices Count! wondered: In October 2017 Iowa launched the 5-2-1-0 Healthy Choices Count! campaign. This is an educational campaign to promote healthy eating • What is 5-2-1-0 and active living for children and families in our state. The campaign Healthy Choices promotes the daily recommendations of 5- servings of fruits and Count!? vegetables, 2-hours or less of recreational screen time, 1- hour of physical activity, and 0-sugary drinks and more water. • How do I implement 5-2-1-0 Healthy Partnering with 5-2-1-0 Healthy Choices Count! Choices Count!? The campaign is supported by the Iowa Department of Public Health, Healthiest State Initiative and Iowa Medical Society. Organizations • Where do I find all the located across the state can participate in Healthy Choices Count and tools and resources? connect to healthy eating and active living resources by visiting www.iowahealthieststate.com/5210. • How do I learn more? Working with Health Care Practices, Schools, Child Care, and Out-of-School Programs Then keep reading! Every participating health care practice, school, child care program, and out-of-school program registers on the Iowa Healthiest State website and uses the 10 Strategies of Success to implement evidence-based strategies to work towards making the healthy choice the easy choice for all kids. The great news is that sites are usually doing a lot of this work already!

How Do I Learn More? Visit www.iowahealthieststate.com/5210 and select the setting that best defines the place where 5-2-1-0 Healthy Choices Count can help you!

Childcare Centers Parents and Caregivers Healthcare Settings School & School-aged Children

5 Health Care The 6 2001, Free Press, 2001, AAP The physical 2013;132(5):958-961. smartphone, Pediatrics. Academy of Pediatrics Dietary Guidance for Healthy Children high blood pressure, high blood pressure, zero-calorie beverage option stroke, Association for Sport and Physical Education, and the media. Association: using a computer, using a computer, The American The

adolescents, important for supporting growth and important for supporting USDHHS and USDA, 2005 Dietary Guidelines Advisory Committee Guidelines 2005 Dietary USDHHS and USDA, American Dietetic may be an important aid to achieving and may be an important Children, Drink and Be Healthy: The Harvard Guide to Healthy Eating, The Harvard Guide to Healthy Drink and Be Healthy: Eat, Youth Overweight Collaborative (MYOC) 6/5/15 2001;107(5):1210-1213.National M.D. February 2004. Position of the playing video games, Maine (2004). Pediatrics. and attention problems. Walter C. Willett, Walter C. Children who are raised in families with active lifestyles are more Children who are raised in families VC, Hogan MJ, Mulligan DA, et al. Mulligan DA, Hogan MJ, VC, Strasburger . AAP recommends keeping the TV and computer out of the bedroom. TV and computer out AAP recommends keeping the 660-677. lower reading scores, The 104: 2004; more water , et al. The use and misuse of fruit juice in pediatrics. et al. , Assoc., colon cancer, and osteoporosis. While most school age children are quite active, While and osteoporosis. colon cancer, Diet. Greer F Am. W, Recreational screen time is screen time used for non-educational purposes. J. diabetes, ears, Y Cochran retrieved during 12/04 from www.health.gov/dietaryguidelines. hour or more of physical activity. hour or more of physical activity. or more fruits and vegetables. or more fruits and hours or less recreational screen time.* hours or less recreational screen time.* iowahealthieststate.com/5210 Screen time includes time spent watching television, Henry J. Kaiser Family Foundation, Issue Brief: The Role of Media in Childhood Obesity, Issue Brief: Kaiser Family Foundation, Henry J. Report, NY. Adapted from the Harvard School of Public Health Prevention Research Center, from the Harvard School of Public Health Prevention Research Center, Adapted NY. Physical Activity for Children: A Statement of Guidelines for Children Ages 5-12. A Statement of Guidelines for Children Activity for Children: Physical Baker S, Sugar-sweetened beverage consumption has increased dramatically since the 1970s; high intake among children high intake among children since the 1970s; beverage consumption has increased dramatically Sugar-sweetened and dental cavities. displacement of milk consumption, is associated with overweight and obesity, old consume no more than 4–6 ounces of 100% juice per day and youth recommends that children 1–6 years Water provides a low-cost, 7–18 years old consume no more than 8–12 ounces. and is a healthy alternative to sugary drinks. * and tablet. Ages 2-11 sugary drinks, for weight maintenance and prevention of chronic diseases such as heart Regular physical activity is essential disease, development, and for optimal immune function in children. High daily intakes of fruits and vegetables among High daily intakes in children. and for optimal immune function development, such as heart disease, with lower rates of chronic diseases adults are associated activity sharply declines during adolescence. and minerals, and vegetables provides vitamins A diet rich in fruits likely to stay active as adults than children raised in families with sedentary lifestyles. likely to stay active as adults than children 5-2-1-0 Message 5-2-1-0 RATIONALE SCIENTIFIC THE diabetes, and possibly, some types of cancers. Emerging science suggests fruit and vegetable consumption may fruit and vegetable consumption Emerging science suggests some types of cancers. and possibly, diabetes, and when total calories are controlled, gain, help prevent weight sustaining a healthy weight. and use of other screen media is associated with an increased prevalence Watching too much television (TV) of overweight and obesity, (AAP) recommends no more than 2 hours of screen time a day and that children under age 2 not watch any hours of screen time a day and that children under age 2 not watch any (AAP) recommends no more than 2 TV or other screen media. Healthy Choices Count! DEFINITIONS For Children with Intellectual and Developmental Disabilities

Disabilities INTELLECTUAL DISABILITY (ID) is a group of conditions characterized by significant limitations in intellectual functioning (i.e. reasoning, learning, problem solving) and in adaptive behavior (i.e. social and practical skills).This disability originates before the age of 18.1

DEVELOPMENTAL DISABILITY (DD) is an umbrella term that includes intellectual disability as well as other disabilities that are apparent during childhood until the age of 22. DDs are likely to be lifelong and can be physical, cognitive, or both. Some examples of DDs include autism spectrum disorder, cerebral palsy, Down syndrome, epilepsy, fetal alcohol syndrome, fragile X syndrome, and spina bifida.1

ELIGIBLE INDIVIDUAL is a child receiving special education services.

Services and Plans BEHAVIOR INTERVENTION PLAN (BIP) is a written plan developed by a Board Certified Behavior Analyst or psychologist or other certified professional to help a child replace problem behaviors with desirable behaviors. It includes a description of the problem behavior, an explanation of why the behavior occurs, and intervention strategies. It can be a stand-alone document or can be speaking attached to an existing education or service plan.2 EARLY ACCESS is a partnership between families with young children, birth the to age three, and providers from the Department of Education, Public Health, Human Services, the Child Health Specialty Clinics, and other community partners. The purpose of this program is for families and staff to work together language in identifying, coordinating, and providing needed services and resources that will help the family assist their infant or toddler to develop and learn.

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continued 7 INDIVIDUALIZED EDUCATION PROGRAM (IEP) is a process where the parents/guardians and school work together to create an IEP for a child, age 3-21, with a disability who needs a specialized instruction. The plan that is developed is reviewed and revised in accordance with special criteria described in the Individuals with Disabilities Education Act. It is based upon the child's individual needs and is developed at an IEP meeting. The plan is reviewed at least once a year and can be revised based on changing needs. At least every three years a reevaluation is conducted to determine ongoing eligibility.4

504 PLAN is a plan that provides services (academic and non-academic) and changes to the learning environment to meet the needs of a child with disabilities as adequately as other students.

INDIVIDUALIZED FAMILY SERVICE PLAN (IFSP) is a written plan for providing early intervention services for a child with I/DD and their family. An IFSP is legally required for all children birth through age 2 who receive services through the Early Access, an intervention program for infants and toddlers with disabilities (Part C of the Individuals with Disabilities Education Act).5

INDIVIDUALIZED HEALTH PLAN (IHP) is the confidential, written, preplanned and ongoing special health service in the educational program. It includes assessment, nursing diagnosis, outcomes, planning, interventions, evaluation, student goals, if applicable, and a plan for emergencies to provide direction in managing an individual's health needs. The plan is updated as needed and at least annually. Licensed health personnel develop this written plan with collaboration from the parent or guardian, individual's health care provider or education team.6

SPECIAL EDUCATION is defined in the Individuals with Disabilities Education Act as “specially designed instruction, at no cost to parents, to meet the unique needs of a child with a disability, including— (i) instruction conducted in the classroom, in the home, in hospitals and institutions, and in other settings; and (ii) instruction in physical education.”4

TRANSITION SERVICES are services that schools are required to provide under the Individuals with Disabilities Education Act for students with disabilities to help them prepare for life after high school. Services must begin no later than age 14.These services are described in the IEP.4

1 Definition of Intellectual Disability. American Association on Intellectual and Developmental Disabilities. aaidd.org/ intellectual-disability/definition. Accessed on June 12, 2016. 2 Drasgow E,Y ell M, Bradley R, and Shriner J. The IDEA Amendments of 1997: A School-Wide Model for Conducting Functional Behavioral Assessments and Developing Behavior Intervention Plans. Education and Treatment of Children. 1999. Vol. 22, (Issue 3): 224-266. 3 Maine Department of Education. Child Development Services. www.maine.gov/doe/cds/. Accessed on June 15, 2016. 4 U.S. Department of Education. Building the Legacy: IDEA 2004. Idea.ed.gov. Accessed on June 15, 2016. 5 Iowa Early Access https://www.educateiowa.gov/pk-12/early-childhood/early-access 6 Iowa Department of Education. Retrieved from https://www.educateiowa.gov/pk-12/special-education

5-2-1-0 Healthy Choices Count! Definitions for Children with Intellectual and Developmental Disabilities 8 Getting Started Health Care 9 These continued . are often used to or brands of It can be hard to limit Below is a list of some of the healthy Below is a list of some smell, temperature, smell, ,

1-5 color may have lower caloric needs. Needs certain foods Unusual or ritualistic eating patterns Selective or “choosy” eating “choosy” Selective or Sensitivity to texture, calories and low in nutrients Preference for foods that are high in Children with certain developmental disabilities, such as Down disabilities, Children with certain developmental syndrome, caloric intake in environments where unhealthy foods are prevalent. Oral-Motor Problems Caloric • • • • Some children with developmental disabilities have oral-motor Some children with developmental to chew and swallow food. problems that can affect their ability be highly processed and less children prefer softer foods which may nutritious. iated with poor diet and lack of physical activity. c o s Food Rewards which tend to be high in sugar and calories, Food rewards, reinforce desired behavior in special education. Mealtime Behavior This can make it Children with I/DD often have difficult behavior at mealtimes. This is a concern because studies more challenging to eat together as a family. to eat show that children who regularly eat with their families are more likely fruits and vegetables. Self-Awareness uences Children with I/DD may not understand the health risks and other conseq as Healthy Eating Challenges Many children with intellectual and developmental disabilities (I/DD) have intellectual and developmental disabilities Many children with face many of They foods and being physically active. difficulty eating healthy well as additional as as typically developing children, the same challenges factors for obesity. challenges and risk with I/DD activity challenges faced by children eating and physical Eating Problems are more likely to have eating Children with developmental disabilities These may include: children. problems than typically developing By learning about the By learning about challenges they face, you are taking an important step towards helping children with I/DD develop healthy behaviors! CHALLENGES HABIT HEALTHY Disabilities Developmental and with Intellectual for Children iowahealthieststate.com/5210 Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 10 . 5-2-1-0 Healthy The Choices Count! Toolkit for Children with Intellectual and Developmental Disabilities includes tools to help address many of these healthy eating and physical activity challenges faced by children with I/DD When Current Disability and What, s safety or Vol 9 (Issue 3):235-240. Berkey CS, Colditz GA. Family dinner and Colditz GA. Berkey CS, 2000; (Issue 3): 145-159. (Issue 3): AE, 2, Vol. Field , Fall 2005; Camargo CA Jr 3 , 6, 7 1, Archives of Family Medicine. Rockett HR, outh with Disabilities: A Critical Need in an Underserved Population. Dev. Youth with Disabilities: . Frazier AL, Frazier Activity for and Kerwin ML. Early Oral-Motor Interventions for Pediatric Feeding Problems: and Kerwin ML. , including: including: Physical amaki K. Obesity and Secondary Conditions in Adolescents with Disabilities: Addressing the Need of Adolescents with Disabilities: Obesity and Secondary Conditions in Yamaki K. ol 8 (Issue 3): 309-316. Vol 8 (Issue 3): Vol 3 (Issue 2):156-170. April-June 2008;Vol.11 (Issue 2): 141-48. (Issue 2): April-June 2008;Vol.11 Eicher P ol 127 (Issue 6): e1565–e1574. Vol 127 (Issue 6): 2015; 2014; Rifas-Shiman SL, Fiese B. Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents? Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Fiese B. , A, 2011; Journal of Early and Intensive Behavior Intervention. Curtin C, Hubbard K., Sikich L., et al. Obesity Prevention for Children with Developmental Disabilities. et al. Sikich L., Hubbard K., Curtin C, w. A., needs Behavioral challenges or support Need for close supervision Tiring more easily Tiring more issues Mobility communication Different social and

Bandini L, Danielson M, Esposito L, et al. Obesity in Children with Developmental and/or Physical Disabilities. Obesity in Children with Developmental and/or Physical et al. Esposito L, Danielson M, Bandini L, Manno CJ, Fox C, Manno CJ, Must Hammons Gillman MW Rimmer J, Rowland J, Rimmer J, Rimmer J, Rowland J. Health Journal. and Ho Obesity Report. Pediatrics. diet quality among older children and adolescents. Neurorehbilitation. an Underserved Populatin. Journal of Adolescent Health. 2007.41:224-229.

Healthy Habit Challenges for Children with Intellectual and Developmental Disabilities Safety Concerns have concerns about their child’ Families of children with I/DD often Attitudes on compe- When the emphasis of an activity is may be children with I/DD tition and winning, team sports. excluded from group activities and Self-Monitoring For example, with self-monitoring. Children with I/DD may have difficulty level of intensity while exercising. This a child may struggle to keep up a certain daily recommendations for moderate to means they may have trouble meeting vigorous physical activity participation in sports in order to child’s risk of injury and may restrict their protect them. Inclusivity with I/DD in physical education Including children do If instructors adaptation. programs may require not make the necessary or lack necessary equipment, program adaptations, children with I/DD may be left out. 1 2 3 4 5 6 7

• • • • • Physical Activity Challenges Activity Physical Limitations Functional to being serve as barriers limitations that with I/DD may have Children active, physically HEALTHY HABIT CHALLENGES for Children with Specific Disabilities

Recommendations to Children with disabilities face different challenges to adopting healthy eating help families and habits depending on their specific disabilities. Understanding a child’s unique caregivers meet special challenges will help you plan healthy mealtimes and activities that meet their dietary needs: needs. Here are some of the health challenges faced by children with specific disabilities. • Consult a health care provider or dietician to help plan meals and snacks that reflect a child’s specific dietary needs.

• Ensure teachers and service providers understand a child’s dietary needs.

• Limit portion sizes at lunch and snack times as appropriate.

• Use a hunger scale to help a child identify when they are hungry Children with Down Syndrome or full. • Decreased resting metabolic rate may cause children with Down syndrome to burn fewer calories when they are not moving compared to their typically • Avoid food rewards, developing peers. which add unnecessary calories to a child’s diet. • Low muscle tone can lead to more fat mass and less muscle mass in the body. • Hypothyroidism affects 30-50% of children with Down syndrome and can cause increased hunger, decreased metabolism, and a higher risk of obesity. • W eak oral-motor skills make it difficult to chew raw fruits and vegetables and to eat other hard foods.1

Children with Down syndrome are at a high risk of developing obesity. It’s important to make accommodations to ensure these children develop healthy habits from a young age to prevent excess weight gain.

iowahealthieststate.com/5210 continued 11 Getting Started 12 Accessed on June 16, Comparative 3 www.ncbi.nlm.nih.gov/books/ 2 can lead to constant food can lead to constant www.pwsausa.org/basic-facts. Background and Recommendations for 2016. Activity and Disability (NCHPAD): Spina Bifida. Activity and Disability (NCHPAD): can limit mobility which means these children can limit mobility which means these 4 if the facial muscles are affected, a child’s ability a child’s muscles are affected, if the facial Interventions for Feeding and Nutrition in Cerebral Palsy, Interventions for Feeding and Nutrition in Cerebral Palsy, Physical 314-319. can place a child with cerebral palsy at risk of at risk cerebral palsy with a child can place 2013 March. National Center for Biotechnology Information. 2013 March. Disability, Spina~Bifida. Accessed on June 16, 2016. 16, June on Accessed Spina~Bifida. and swallow will be compromised. and swallow No. 94. No. For example, For example, Vol.36 (Issue 6):

2010; chew,

seeking and binge eating. seeking and binge obesity. cause of life-threatening risk for obesity. are often sedentary and at an increased

malnutrition. to suck, Neurological impairments suggest a need for fewer calories. and short stature suggest a need for Slower metabolism common genetic makes PWS the most to obesity Genetic predisposition suggest a need for fewer calories. Slower metabolism and short stature Chronic hunger and an inability to feel full Chronic hunger and difficulties Feeding Effectiveness Reviews,

Pradi-Willi Syndrome Basic Facts. Pradi-Willi Syndrome Association. Pradi-Willi Syndrome Pradi-Willi Syndrome Basic Facts. National Center on Health, Ferluga ED, Archer KR, Sathe NA, et al. Sathe NA, KR, Archer Ferluga ED, Murray J, Ryan-Krause P. Obesity in Children with Down syndrome: Obesity in Children Ryan-Krause P. Murray J, NBK132431/#introduction.s1. Accessed on June 16, NBK132431/#introduction.s1. 2016. Pediatric Nurs.

Concerns Concerns about malnutrition may lead families to feed their children foods that are high but in are It calories, not is nutritious. important to help families select needs. nutritious and meet their child’s foods that are both A modified diet and inclusion in physical activity can reduce the obesity risks A modified diet and inclusion in physical for children with spina bifida. • • • physical a properly managed diet and regular Despite their many risk factors, maintain a healthy weight. activity can help children with PWS • • • Healthy Habit Challenges for Children with Specific Disabilities 3 4 www.nchpad.org/222/1443/ Management. 2 1 Children with Spina Bifida Children with Cerebral Palsy Cerebral with Children Children with Prader-Willi Syndrome (PWS) Syndrome Prader-Willi Children with

HEALTH CARE CHALLENGES for Children with Intellectual and Developmental Disabilities

The 5-2-1-0 Healthy Children with intellectual and developmental disabilities (I/DD) face a number Choices Count ! of challenges when it comes to accessing care. Below are some examples of the Toolkit for Children challenges that can increase their risk for obesity. By recognizing the challenges with Intellectual and they face, health care providers can start working to improve access and quality Developmental of care for children with I/DD. Disabilities contains tools that help Disparities in Care Given the number of other health issues to address with patients with I/DD, address many of the healthy eating and physical activity are often overlooked. This means that health care children with I/DD may not receive the same type of healthy habit counseling as challenges faced by their typically developing peers.1 children with I/DD. Barriers to Care Health care providers may lack training, experience, and comfort working with children with I/DD. This can impact the quality and effectiveness of care.2

Medication Certain medications are critical in the treatment of children with I/DD but can interfere with appetite and metabolism. Children who take these medications may experience additional challenges to maintaining a healthy weight.1

Lack of Training Community service providers, such as case managers and behavioral health professionals, play a significant role in the lives of children with I/DD, but typically do not receive training on healthy eating and active living behaviors.

Multiple Services and Transitions Children with I/DD receive support from many different groups of people within schools, health care, and community settings. As they move from early childhood to adolescence to adulthood, their eligibility for services changes. These multiple services and transitions can be difficult for families to navigate. It is particularly difficult to coordinate the use of consistent messages and strategies to promote healthy eating and active living behaviors across settings.2

1 Bandini L, Danielson M, Esposito L, et al. Obesity in Children with Developmental and/or Physical disabilities. Disability and Health Journal. 2015;V ol. 8(Issue 3): 309-316. 2 Maine Primary Care Association. Health Care Safety Net Series: Leverage Points in Delivery System Reform: Improving Care for Complex Patients. April 2013.

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13 SPECIAL HEALTH SERVICES for Children with Intellectual and Developmental Disabilities

Children with School or Program-Based Services, Home, and Community- intellectual and Based Services developmental disabilities may receive Board Certified Behavior Analysts (BCBA) analyze children’s behavior in services from multiple different settings to develop plans that promote desirable behavior. professionals within child care, school, health Paraeducator is an unlicensed, specially trained individual, that provides care, community, and educational support to children with special needs under the direct home settings.These supervision of a teacher and for health services under the direct supervision professionals are part of of a school nurse. Determination is based on student's need identified a child’s support team. during the IEP evaluation process. It is helpful to Occupational Therapists (OT) provide services that enhance children’s understand the services ability to function in different environments. An OT may teach daily living provided skills like eating and cooking; fine motor skills like using scissors and tying by these different shoes; and gross motor skills like walking. An OT can also address sensory professionals in order processing issues, such as oversensitivity to certain food textures. to work together to support children’s Physical Therapists (PT) provide services that address children’s posture, healthy behaviors. muscle strength, mobility, and range of motion.

continued 14 SocialW orkers provide services that address children’s mental or behavioral health.They provide positive behavioral support, classroom support, and individual and group counseling in the school, home, and community.They help children and their families access resources outside of school and can help coordinate services.

Special Education Teachers provide specially designed instruction to help children achieve their IEP goals and progress towards lessening the gap with peers. Special education teachers work directly with children but also determine how children can be accommodated in regular education settings.

Speech and Language Pathologists (SLP) provide services that address children’s communication problems, such as impaired articulation, and social skills, such as starting a conversation or taking turns.

Behavioral Health Intervention Services (BHIS) work directly with children in their home or community to provide support services. BHPs implement Individualized Treatment Plans under the supervision of more highly-trained staff.

Case Management is a service for eligible children diagnosed with a mental health, intellectual or developmental disability or for children ages 0 to 5 who are at risk of developmental delay. Case managers provide support to children and their families while connecting them to resources and services in their own communities including Iowa waiver based services.

Direct Support Professionals- work directly with children who need support and supervision for daily living, social skills, and behavior through special programs in homes and communities. Examples include respite provider, supported community living (SLC), home health aid, and consumer directed attendant care (CDAC).

Family and Educator Partnership (FEP) encourages and promotes positive partnerships between parents and educators so that children with special needs are successful. Our FEP coordinators are parents of children or young adults with special needs, so they share a unique perspective with the families they serve. They provide support and information to families individually and through parent workshops and support groups. They also facilitate linkages between families, schools, and community agencies.

School Nurse is a registered nurse holding current licensure recognized by the Iowa board of nursing who practices in the school setting to promote and protect the health of the school population by using knowledge from the nursing, social, and public health sciences.

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15

Services for Children with Intellectual and Developmental Disabilities

COORDINATE SERVICES to Support Healthy Outcomes for Children with Intellectual and Developmental Disabilities

A parent or guardian typically has the difficult job of accessing and coordinating the many services their child receives. Even for the most knowledgeable and organized parent, the demands of coordinating services can be overwhelming. By improving communication and coordination, the professionals who support children with intellectual and developmental disabilities (I/DD) can reduce the burden on families and increase the likelihood that children with I/DD adopt and maintain healthy eating and active living behaviors.

Below are some basic guidelines to help you improve your communication and coordination efforts to support children with I/DD and their families.

Guidelines for improved communication and coordination: • Increase your awareness of the challenges to eating healthy and being active faced by children with I/DD and their families.

• Become familiar with special education laws, guidelines, and personnel.

• Learn more about funded services and personnel.

• Recommend services that promote healthy eating and physical activity in a treatment plan or community care plan.

• Use consistent strategies to promote healthy eating and physical activity be a across all education, behavior, and service plans. team • T rack and adjust strategies in a child’s service plans as needed to reflect any player! changes in a child’s health and educational needs. • Attend planning meetings with the rest of a child’s team whenever possible, either in person or by phone or video conference.

• Consider rotating the location of planning meetings between the offices of different team members, such as the school, health care practice, and community service providers’ offices to increase participation.

• Use the same terminology and respectful language as the rest of a child’s team when talking to and about a child with I/DD.

• Call on liaisons who understand different settings to explain and share information about a child’s needs. In schools a liaison might be the school nurse or social worker. In health care practices there may be a designated member of the team who helps coordinate services for complex patients. iowahealthieststate.com/5210

16 TIPS FOR COMMUNICATING with Children with Intellectual and Developmental Disabilities

Children are more likely When talking to a child with a disability: to be motivated to listen • Learn about how a child communicates before you talk to the child whenever to possible. adults about making healthy choices when they • Speak directly to the child, not to the aide, parent, or caregiver. feel respected and appreciated. • Do not make assumptions about a child’s cognitive abilities just because he The following tips or she cannot communicate clearly. can help you work with children with intellectual • Do not assume that a child with a specific disability is just like other children and developmental with the same disability. disabilities (I/DD) to feel positive about • Give a child with a disability more time to respond to your questions and to themselves and develop ask questions of their own. healthy behaviors. • Avoid overcompensating or condescending by offering exaggerated praise or too much attention for every day accomplishments.

• Find out how a child understands their disability. Use the same words the child uses to describe their disability and avoid using your own terms.

When speaking about a child: • Use “person first” language. Say: a child with autism, not an autistic child. Or say: she is a student with Down syndrome, not she is a Downs student.

• Avoid negative labeling. Saying someone is “crippled by cerebral palsy” or “suffers from developmental delays” devalues the individual and can be hurtful and stigmatizing.

• Emphasize what a child can do, not what they can’t.

• Understand that a child’s disability does not define them—it’s just one part of who they are.

• Seek additional help from someone who knows the child well when you want more information about a child’s unique strengths and weaknesses.

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recommended goals, contain recommended goals, 's PE). d ports A including the child’s diagnosis and recommended goals related to nutrition or including the child’s physical activity. plans. Write these into a child’s and help reach goals.

or brand of food? Set goals that are both measurable and attainable. Include non-food rewards as strategies to reinforce desirable behaviors Does the child have the same basic motor skills as their peers? Does the child have the same basic What skills are weakest? What skills are strongest? What skills does the child need to work on most to improve independence? personal goals for sport or recreation? What are the child’s Does the child eat at least 5 fruits and vegetables each day? Does the child eat at least 5 fruits and of foods? Does the child eat a very limited number Is the child oversensitive to the taste, Does the child have difficulty chewing or swallowing? Does the child have difficulty chewing at snack and mealtimes? Does the child display difficult behavior slowly? Does the child eat too quickly or too Seek guidance from a child’s health care provider. health care provider. Seek guidance from a child’s hil F sup ( appropriate services to address their needs. plans ensures that the child receives consider when developing healthy eating Here are some guiding questions to and physical activity goals. Guiding Questions: Healthy Eating c Including goals to create updated plans. needs and meet annually with families activity in a child’ related to healthy eating and physical Family Service Plan ized Family Service Plan including the Individual plans, Education and service or Individualized (IEP), ized Education Program (IFSP), Individual (IHP), with intellectual and developmental disabilities (I/DD). developmental disabilities (I/DD). with intellectual and Physical Activity Physical Other Tips: Other • • • • • • • • • • • • • iowahealthieststate.com/5210 to Support Healthy Habit Goals for Children with Intellectual with Intellectual for Children Habit Goals Healthy to Support Disabilities and Developmental EDUCATION AND EDUCATION USE SERVICE PLANS PLANS SERVICE Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 19 continued independent more , Is the student aware of different places to Does the student have basic food Can the student identify various places Can the student complete a membership buy healthy food in the community? handling and kitchen safety skills? and programs to be physically active in the community? application for a local recreation facility? • • • • Adults Adults Young eens and Teens and Does the student understand the 5-2-1-0 message? Does the student understand the 5-2-1-0 between healthy and Does the student understand the difference Can the student plan a healthy meal? to make healthy meals? Can the student follow simple recipes read food labels? Does the student understand how to make healthy choices when Does the student understand how to unhealthy choices? grocery shopping? • • • • • • life after high school by including healthy eating and physical activity goals needed as a result of supports and services. the individual's disability in the IEP's transition Healthy Habit Goals: Guiding Questions for Setting The transition out of high school can be a challenging time for young adults are I/DD with People with intellectual and developmental disabilities (I/DD). eligible for different types of services prior to turning 14 years old, and may no longer receive adult life. ease the shift from high school to transition plan can the support they are used You can help prepare to. a young person to lead A a healthier comprehensive iowahealthieststate.com/5210 with Intellectual and Developmental Disabilities Developmental and with Intellectual Planning for transitions. Once an eligible the individual turns 14, the IEP must address transition supports and services needed as a result of the individual's disability. TRANSITION PLANS PLANS TRANSITION USE Habits for Healthy to Support Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 0 2 Everyone on a child’s team a child’s on Everyone can address healthy habit habit healthy can address young person’s goals in a plan. transition Adults with Intellectual and Developmental Disabilities Young Treatment Plan. Workers Social Teens and can help a student find can help a student Teachers Therapists can work with a student to enhance can model healthy habits and identify ways their child can become can model healthy habits and identify Education

can ensure a student has a basic understanding of Educators can ensure a student Physical or Speech and Language Pathologists Can the student use public transportation to access local recreation facilities? local recreation to access transportation use public the student Can with and communicate recreation facilities navigate local Can the student that or activity modifications any equipment inquire about Can the student Health Care Providers can work with a student to set Occupational IEP transition Case Managers can align healthy habit goals in the Families personnel? (e.g. find bathrooms and changing rooms or ask about schedules rooms or ask and changing find bathrooms (e.g. personnel? and fees) he or she needs? more independent. proper nutrition. identify physical activity outside of school and opportunities for into to develop in order to stay active skills a student needs adulthood. can work with a student to develop the social skills needed to can work with a student to develop access community resources. personal healthy habit goals. fine motor skills for use in cooking. ized Individual plan with goals in the student’s Everyone Plays a Role! Everyone Plays • • • • • • • • • • Transition Plans to Support Healthy Habits for Use Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care

1 2

EATING THY LTHY HEA Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 2 2 Adults Young and Teens for (in the ‘Getting Started’ section of this toolkit) (in the ‘Getting Started’ section of this toolkit) Texture Role in Promoting Healthy Eating for “Choosy” Eater (in the Address Eating Problems in Children with I/DD Address Eating Problems in Children at 5-2-1-0 Healthy Choices Count! resources ransition Plans to Support Healthy Habits Transition Plans to Support Healthy

Started’ section of this toolkit) ‘Getting the

Children with I/DD Children with I/DD with I/DD Healthy Foods by Tools to Ideas for Healthy Snacks Handling a Support Healthy Habit Goals for Use Education and Service Plans to Healthy Habit Challenges for Children with I/DD (in Healthy Habit Challenges “Choosy” Eating a Problem? When is Problems Oral-Motor and Sensory Use Everyone Plays a For more ideas to promote healthy eating for children, check out the eating for children, For more ideas to promote healthy other www.iowahealthieststate.com/5210 Get ideas for ways to meet the needs of children with Get ideas for ways to meet the eating problems: • • • • for children with I/DD: Support healthy eating goals • Learn about common eating problems for children with eating problems for children Learn about common I/DD: • • • • • , dairy O TO and cake, CHOICES beans, protein sources , cookies, , iowahealthieststate.com/5210 include foods and drinks high in sugar and/or salt such as soda, candy and chips. fish and poultry, fish and poultry, healthy fats such as nuts, and avocados. seeds, Here are ideas for how Here are ideas for to promote healthy with eating for children intellectual and developmental disabilities (I/DD). Each bolded item represents a handout in this toolkit! CHOICES HEALTHY fruits and include water, whole grain vegetables, foods, such as eggs, PROMOTE HEALTHY EATING HEALTHY PROMOTE HOW HOW for Children with Intellectual and Developmental Disabilities Disabilities Developmental and with Intellectual for Children UNHEALTHY Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 3 2 iowahealthieststate.com/5210 A PROBLEM? our observations of a child’s of a child’s Your observations 2016. Accessed June 15, Just a Phase or Something More

2009. These professionals can determine when an eating Speech and Language Pathologist to observe the child at only eat a certain brand of crackers. with others. meal lasts longer than the child has tantrums or his For example, 40 minutes. The number and types of foods a child eats decreases over time. The number and types of foods not provide adequate nutrition. The food that a child eats does of foods that are offered. A child refuses an increasing number such as demanding to behavior, A child develops ritualistic eating or vomits food. spits up, A child gags, A child refuses to feed himself. limited diet gets in the way of their ability to eat A child’s eating problems. child’s Mealtimes revolve around the The child has significant weight gain or loss. behavior requires further attention. Consider asking a professional such as an Occupational Therapist, Consider asking a professional such as an Occupational or mealtimes. • • • • • • • • • Kennedy Krieger Institute. Picky Eating, Picky Kennedy Krieger Institute. Choosy eating is common and is often a sign that a child is is common and is often a sign Choosy eating become less Choosy eaters typically independent. becoming more in require professional support but some may picky over time, their eating habits. order to change the problem. can help identify the extent of eating behavior When to be Concerned Serious? www.kennedykrieger.org/overview/news/picky-eating-just-phase-or- August 31, something- more-serious.

Seek professional advice Seek professional when choosy eating physical impacts a child’s or mental health. are Eating problems complex and generally require a team approach. Acting out at meal and snack times may be a coping strategy for child’s sensory or oral-motor problems which are causing discomfort.

When is When “CHOOSY” EATING “CHOOSY” Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 2010, 4 2 2 and temperature Autism Spectrum Disorders. smell, , color 238-246.

Often smells non-food items Accepts only foods with specific Craves intense flavors textures or temperatures and smells and smells Strongly prefers certain tastes their mouth Over-stuffs Strongly dislikes certain tastes Avoids chewing their food • • • • • • • DECREASED SENSITIVITY: Sensory Problems Sensory problems involve increased or decreased sensitivity to the texture, of certain foods. These problems can These problems of certain foods. impact the types and amount of food that a child Identifying a child eats. has a sensory problem can help families and caregivers determine how to ensure they eat a healthy diet. What are signs of sensory problems? INCREASED SENSITIVITY: here.doh.wa.gov/materials/nutrition-interventions/15_CSHCN ol.110(Issue 2): V or 1 getting 2016. Food Selectivity and Sensory Sensitivity in Children with AND SENSORY SENSORY AND and Bandini L. Washington State Department of Health. Accessed on June 16,

93-6. Curtin C, OR TOR food stuck in the mouth, difficulty coordinating mouth muscles hard-to-chew foods temperature around the mouth cleft palate mouth such as an unusual bite, to swallow Avoids eating raw or other Chokes or gags when trying Sensitive to touch and such as a Oral facial defects, Low muscle tone around the Abnormal oral-motor patterns NI_E10L.pdf. 2010 Feb; Association. American Dietary Journal of the 3rd Edition: • • • • • •

Oral-motor problems can affect a ability to chew and swallow child’s the child may prefer As a result, food. Soft foods include softer foods. healthy choices like steamed or canned vegetables as well as unhealthy choices like French fries It is important to or ice-cream. ensure that children with oral-motor problems eat foods that are both healthy and match their preferences. What are signs of oral-motor problems? 1 Glass R, Wolf L. Oral Motor Feeding Problems. Nutrition Interventions for Children with Special Health Care Needs. Oral Motor Feeding Problems. Wolf L. Glass R, 1 Cernak S, 2 Some children with intellectual and developmental disabilities (I/DD) have intellectual and developmental disabilities Some children with it more challenging and/or sensory problems that make oral-motor problems type of problem and Below is some information on each to eat a healthy diet. ways to identify them. Oral-Motor Problems , or , sensory iowahealthieststate.com/5210 If you notice that a child If you notice that oral- shows signs of an motor or sensory share those problem, concerns with the they family and suggest consult a health care Their provider provider. can make a referral for speech and language, occupational, behavioral assessments so an appropriate treatment plan can be developed. ORAL-MO PROBLEMS Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 5 2 continued added or like carrots, melon, dd some flavor! Experiment with spices A ou can freeze just about anything! If You can freeze just about anything!

carrots, jicama, and celery sugar bell peppers,

Rice cakes Unsalted nuts

Snap peas berries, grapes like peas, and green beans Plain popcorn Frozen vegetables, Whole grain toast or crackers eggie sticks, like Veggie sticks, Frozen fruit, Whole grain cereal with minimal

Children may be more willing to try Children may ike cinnamon or your favorite spice or herb. • TIP: • • l • • • •

a child strongly prefers frozen foods, try foods, a child strongly prefers frozen sticks and freezing other foods like cheese breads. Crunchy Frozen • • TIP: ry introducing children to new foods based on children to new foods based Try introducing and other healthy foods. and other healthy vegetables, Honey Fuji and Gala Add a sprinkle of bread crumbs for Puree vegetables together with fruit! Puree vegetables together with Braeburn, Crisp, such as berries, or apples pears, Avocado Cream of wheat Yogurt Hummus squash Roasted chickpeas

Pureed fruit, Creamy nut or seed butters such as parsnips or Cooked vegetables, Freeze dried apples and dried mangos Roasted vegetables Apple varieties like Roasted red or white potatoes (with skins) iowahealthieststate.com/5210 • • • • • TIP: added crispiness! Crispy TIP: Creamy Many children with intellectual and developmental disabilities are extra sensitive to the disabilities are extra with intellectual and developmental Many children get them to families and caregivers to This can make it hard for foods. texture of certain try new fruits, BY TEXTURE BY FOODS HEALTHY like how the foods feel. new foods if they prefer. the textures they • • • • • • • Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 6 2 Food like raisins and dried apricots like raisins Grapes tomatoes Cherry Hard boiled eggs Hard boiled String cheese Peas Edamame Dried fruit, Dried fruit, Squishy • • • • • • • .abilitypath.org/health-daily-care/health/ www visit: Texture

growth-and-nutrition/ articles/obesity/pdfs/parent_toolkit-_food_chaining.pdf. Presenting foods by texture can be used in food chaining, an individualized an individualized chaining, by texture can be used in food Presenting foods of food a child will eat. to increase the number and types approach used chaining can be done at a child care program, school or home. For more school or home. care program, chaining can be done at a child information on food chaining,

Scrambled eggs Cottage cheese Mashed sweet Mashed Applesauce Mashed bananas Mashed (no sugar added) with or without with or yogurt potatoes Healthy Foods by • • •

• Lumpy • Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care . 7 2 such as continued Food Chaining: A visual aid, such as A visual aid,

ry using the simple “My Food Diary” Try using the simple A timer or vibrating watch can

. ry using the “Mindfulness of Hunger Scale” Try using the . Centers for Disease Control and Prevention: while eating. V T by Cheri Fraker or visit www.abilitypath.org/health-daily-care/ then tasting, and ultimately eating the new food. then tasting, vibrating watches, and visual aids can improve meal pacing for children vibrating watches, ADDRESS ry putting a different image for each snack or mealtime around the face image for each snack or mealtime Try putting a different Timers, who eat too quickly or too slowly be set to mark the appropriate time to pause between bites. can demonstrate activities to extend mealtimes a sequence of pictures or photos, and make them more enjoyable. health/growth-and-nutrition/articles/obesity/pdfs/parent_toolkit- _food_chaining.pdf. Food Diaries who need help improving their diets. Food diaries are useful for children tracks the types and with help from their family and caregivers, A child, They may also record environmental quantities of food and beverage consumed. meal is eaten or whether such as where the factors that impact mealtimes, a child is watching The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Solve Feeding Problems, Eating, The Proven 6-Step Plan to Stop Picky Your Child’s Diet Hunger scales can help children become the need for attention or stimulation. mindful of their level of hunger For more information about food chaining, check out the book For more information about food chaining, www.mindfuleatinginfo.com/uploads/5/1/1/8/5118392/ found here: mindfulness_ of_hunger_scale.jpg. Meal Pacing A schedule helps a child get into a routine of eating at regular meal and snack child get into a routine of eating at A schedule helps a times. see it. schedule where the child can easily Post the of a clock. Food Chaining to increasing the structured approach Food chaining is an individualized, or It can be used when a parent eat. number and types of food a child will The child starts by just seeing and caregiver exposes a child to a new food. touching, www.cdc.gov/healthyweight/pdf/food_diary_cdc.pdf. Hunger Scale Some children find it difficult to distinguish hunger from other needs, template created by the U.S. Daily Schedules each part of their day I/DD do best when they can anticipate Many children with TO iowahealthieststate.com/5210 EATING PROBLEMS EATING Disabilities with Intellectual and Developmental in Children While children with children While and intellectual developmental often (I/DD) disabilities to challenges face food healthy making wide a are there choices, help to tools of range healthier adopt them is Here habits. eating some about information tools. these of

OOLS TOOLS able of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 8 2 or The

marbles, and under- visit: play THEN Although originally used to originally used to Although

Caregivers and families can create a Caregivers and families okens can later be traded for larger Tokens can later be

For more information, For more a caregiver might show a child a picture of a snack with a caregiver might show a child a picture eat FIRST For example, okens should be tangible non-food items, such as stickers, such non-food items, okens should be tangible like trying a new vegetable or sitting quietly at the table for fifteen or sitting quietly at the table like trying a new vegetable T

, Aids “First-Then” board shows a picture of an object or action followed by a picture “First-Then” board shows a picture Picture Exchange Communication System (PECS) is another type of visual aid Picture Exchange Communication of healthy eating and physical activity that can be used to promote a variety Learn more about PECS at www.pecsusa.com/pecs.php. behaviors. Address Eating Problems in Children with Intellectual and Developmental Disabilities Tools to cards, that family members or caregivers can give to a child immediately after he or caregivers can give to a child that family members cards, desired activity. or she completes the or visiting a friend. rewards like extra outdoor play time Visual have trouble using language, Visual aids are useful for children who “First-Then” board. One type of visual aid is a standing and following directions. A of a reward. set with the word “play”. “eat” followed by a picture of a swing the word Social Stories Social a describes story a social and images, words appropriate developmentally Using child finds challenging. or concept that a situation help children engage in social situations, social stories can address a wide range stories can address social situations, engage in social help children including eating problems. of issues www.carolgraysocialstories.com/. Token Systems to try new foods or to be used with children who refuse A token system can mealtime behavior. address challenging for desirable allows a child to earn a token or reward simple system that behavior minutes. Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 29 out For your balance cranberries, to Grape-Nuts, low-sugar options apples, good idea good s a s

Thins Wheat Triscuits or whole grain, like Cheerios, Raisin Bran or Mini-Wheats be sure there is just fruit and no added sugar in the bag) or tortillas pitas, juice Canned fruit (in 100% or water) apricots, and fruit leathers with little or no added sugar Cottage cheese Cheese cubes Unsweetened yogurt Nuts or nut butter Baked tortilla chips Popcorn Whole grain crackers like Breakfast cereals – choose Frozen fruit (check the label to Whole wheat English muffins, Applesauce (unsweetened) Applesauce (unsweetened) Dried fruit – try raisins, • • • • • • • • • • • It’ next snack try eating a fruit or one of these WITH vegetable foods: snacks by serving foods from different food groups. Some other popular fruit Some other popular forms include: • • or purple Mix it up! Serve fresh fruit as a salad or kabobs! green,

Tangerines Strawberries Raspberries Plums Pineapple Pears Peaches Oranges Nectarines Kiwifruit Grapefruit Clementines Cherries Cantaloupe Blueberries Blackberries Mandarin Oranges Bananas Honeydew melon Apricots Grapes – red, Apples • • • • • • • • • • • • • • • • • • • • • • Fruit is a nutritious and Fruit is a nutritious for naturally sweet option Choosing fresh fruit snacking. getting no guarantees you’re added sugar: SNACKS and OR OR Y hummus, F green, H red, LT guacamole, and salad dressings EAS iowahealthieststate.com/5210 salsa, and nut butters are all great and salsa, for dipping or spreading! YUM! Bean dips, butter and raisins...anyone remember ants on a log? yellow Broccoli Baby carrots Celery sticks – add some nut Cucumber slices Pepper strips – Snap peas Snow peas String beans Grape or cherry tomatoes Zucchini slices • • • • • • • • • • include: Boost overall nutrition with Boost overall nutrition healthy snacks. going all day Keep your energy long! that can be Popular vegetables served raw with healthy dips, spreads, HEA ID Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 30 “choosy” and then quietly instead of over one day or per EATER Here are ten tips for handling a Here are ten tips for s if a A food jag is when a child eats only a certain food A food jag is when a child eats only This will pass overeating.

USDA .” Children believe to Aim for at . and lead and oung Children, Y not on the food. not a huge array Most kids are eating more variety than you think. Most kids are eating more variety than Treat food jags casually. Forcing a child to eat more than they want can appetite. Forcing a child to eat more than they Trust your child’s

Set reasonable time limits for the start and end of a meal Set reasonable time limits for the start Focus on your Stay positive and avoid criticizing or calling Serve food plain and respect the Avoid being a short-order cook Look at what a child eats over several days, Look at what a child eats over several Substitute a similar food Provide just two or three in time. choices, cause conflict cause remove the plate. eater “picky any child a what we say! “no foods touching” rule if that’ important to your child. by making and offering the same food for the whole family child does not like a certain food. instead of squash, For example, offer sweet potatoes. meal. least one food everyone will eat. for a period of time. They usually do not last long. for a period of time. Then let your of food. Keep in child decide. mind your child may choose nothing and that is okay! positive eating child’s behavior, 4. 7. 3. 5. 6. 9. 8. 1. 2. 10. Adapted from “Nibbles for Health” Nutrition Adapted from Newsletter for Parents of Food and Nutrition Service. eater to make meal times more pleasant again: eater to make meal times more pleasant What do you do if your child refuses a whole meal because something they your child refuses a whole meal because What do you do if anything other than fruit their plate? Or if they refuse to eat don’t like touched Or maybe your would only eat peanut butter sandwiches? and two days ago any interest in food at all! child is not showing not uncommon. These behaviors are consult Learn

“choosy”

iowahealthieststate.com/5210 Handling a Handling If you are concerned weight about your child’s or eating habits, your health care provider. your health care provider. may just be your child’s may just be your child’s first steps in learning to make decisions. Often, choosy eating is Often, is a sign your child growing up and becoming more independent. What seems how to handle eating challenges and avoid conflict so meals don’t become a tug-o-war of control. “CHOOSY” Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 31 iowahealthisestate.com/5210 strategies with other team. members of a child’s about how a child’s medications may affect appetite. eating goals and strategies in education and a child’s service plans. challenges to making healthy food choices and develop strategies to address them. food allergies about a child’s and dietary restrictions. an eating problem that interferes with a child’s physical or mental health. Share effective healthy eating Inform all team members Ensure alignment of healthy specific Learn about a child’s Inform all team members Request services to address Request services to • • • • • • Special Education Teachers School Nurses Case Managers , and home settings. These professionals and home settings. , OTING IN PROM ROLE community A

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opportunities to make healthy choices. difference between healthy and unhealthy food choices. T Offer all children • • Classroom school, Assess the nutritional status and develop nutritional plans. Provide education on special diet modifications • • choosy eating behaviors require closer attention. importance of a healthy, balanced diet. eating behaviors affect their physical and mental health. education goals for a child’s and service plans. choosy eating behaviors require closer attention. that impact eating. skills related to eating. Help determine if a child’s Talk to families about the Determine how a child’s Recommend healthy eating Help determine if a child’s sensitivities Address a child’s Help a child develop motor Dietitian • • • • • • • Speech and Language Pathologists Health Care Providers TING EATING LTHY HEA Disabilities Developmental and with Intellectual for Children the child team can play a role in helping member of a child’s Each support team. are part of a child’s and make healthy choices. develop healthy behaviors Occupational Therapists Children with intellectual and developmental disabilities (I/DD) receive services from multiple (I/DD) receive services from and developmental disabilities Children with intellectual child care, professionals within YS PLA RYONE EVE

Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 32

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REW NON-FOOD NON-FOOD Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 33 iowahealthieststate.com/5210 (in the ‘Getting Started’ section of ‘Getting Started’ section (in the Healthy Choices Count! resources at racker T 5-2-1-0 ransitioning to Non-Food Rewards for Children with I/DD ransitioning to Non-Food Rewards Habit Goals for Children with I/DD this toolkit) for Children with I/DD

Use Education and Service Plans to Support Healthy Use Education and Service Plans to Preference Assessments for Children with I/DD Assessments Preference Use Non-Food Rewards Activity as a Reward Use Physical T Everyone Plays a Role in Providing Rewards Non-Food Why Prohibit the Use of Food as a Reward? Use of Food as a Why Prohibit the Food Rewards • check out rewards for children, For more ideas to provide non-food the other www.iowahealthieststate.com/5210 Get ideas for ways to reward children without using food: Get ideas for ways to reward • • • reward children without using Implement new strategies to food: • • Learn why it is important to avoid food rewards and important to avoid food rewards Learn why it is I/DD: rewards for children with provide non-food • • O TO REINFORCER is a technical term that describes an object or action used to teach and affirm desirable behaviors for children with I/DD. Reinforcers should be individualized and used as part of a behavior intervention plan. FOOD REWARD is a food used to reward good behavior. food to avoid the use of rewards and provide for non-food rewards children with intellectual and developmental disabilities (I/DD). Each bolded item represents a handout in this toolkit! PROVIDE NON-FOOD NON-FOOD PROVIDE REWARDS with Intellectual and Developmental for Children Disabilities HOW HOW Here are ideas for how Here are ideas for Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 34 and iowahealthieststate.com/5210 encourages kids to encourages kids sends a mixed sugary drinks, ol. 19(Issue 1):41-62. ol. 2 1, 1999;V 2 when they may not be when they may 1, puts them at risk for excess Need for early interventions in the prevention of pediatric How memories of childhood food rules doughnuts, THE USE THE ol. 4 (Issue3):283-293. ol. V Saavedra JM. 1 ol. 159 (Issue12):1111-1114. Vol. even healthy foods, even healthy foods, 2003; cookies, 4 2005; 3, Annual Review of Nutrition. averas EM, Med. REWARD? T

A, Lake Schoolwide food practices are associated with body mass index in middle Eating Behaviors. Adolesc. , .19.1.41 If you are good you can have a cookie: Pediatr. Story M. Krebs NF Arch. Birch L, Lytle LA, AS A A AS Schwartz MB. Development of food preferences. AM, students. 10.1146/annurev.nutr

Kubik MY, Kubik MY, Dattilo school overweith: a review and upcoming directions.. J. Obes.2012. link to adult eating behaviors. DOI:

Birch LL. 4 2 1 Puhl RM, 1 Rewarding kids with food, Rewarding kids and snack times, eat outside of meal and fat, are typically high in sugar, Foods that are used as rewards and can play a role in establishing salt with little nutritional value, foods. kids’ preferences for unhealthy hungry, and can lead to poor eating habits. and can lead hungry, candy, such as Using food, performance as a reward for good behavior and academic pizza, and is a common practice with kids time but at the same foods, Encouraging kids to eat healthy unhealthy foods, rewarding good behavior with message and confuses kids. weight gain and obesity. 3 For . . mind in keep , Special education 5-2-1-0 Healthy FOOD FOOD OF WHY PROHIBIT PROHIBIT WHY NOTE ON FOOD NOTE Choices Count!, we understand these challenges and recommend that adults who work with children with I/DD start out small by avoiding the use of food as a reward. However that the best practice is to eliminate food rewards completely this reason, prohibiting this reason, the use of food as a reward may have additional challenges. At teachers often rely on effective food as a quick, way to reinforce desirable behavior REWARDS IN REWARDS SPECIAL EDUCATION: for Rewards are common but can be a all children, particularly big part of the lives of children with intellectual and developmental disabilities (I/DD). Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 5 3 continued BEHAVIOR TARGETED Pass around this Pass around this and service providers and service Not running in the hall teachers, teachers, TRACKER THE REWARD? THE REWARD? Tech WHO PROVIDED (NAME AND ROLE) (NAME Cindy, Ed Cindy, racking the food rewards a child receives over the course of a over the course a child receives the food rewards Tracking families, show how often day will reinforce desirable behavior. rely on food to to capture the type adult a child spends time with tracker to each and the providing the reward, person of food being used, can the team Once the tracker is complete, targeted behavior. to replace the food rewards. work together Name: Child’s Date: FOOD REWARD Ex: Goldfish Ex: iowahealthieststate.com/5210 FOOD REWARDS FOOD Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 36 BEHAVIOR ARGETED TARGETED Not running in the hall Not running THE REWARD? REWARD? THE Tech WHO PROVIDED PROVIDED WHO (NAME AND ROLE) (NAME Cindy, Ed Cindy, FOOD REWARD FOOD Ex: Goldfish Ex: Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 37 continued Give the child

TS TS At the end of the

Below are a few The RAISD tool can be , or service provider may conduct this assessment. , , or service provider may conduct this assessment. or service provider may conduct , www.kennedykrieger.org/sites/default/files/patient-care-files/

caregiver caregiver If left alone, what would the child do? what would the child If left alone, others? What does the child like to do with What activities help the child feel calm? What activities help the child stay focused? Where does the child like to go? What are your favorite activities at school? What are your favorite activities at after school and on the weekends? What are your favorite things to do What are your favorite subjects in school? What do you like to do with your friends? • • • • • A teacher, • • • • A teacher, Informational Interview (structured) Interview a few individuals who know the child well using a survey tool. Assessment for Individuals with Severe Disabilities (RAISD) The Reinforcement is one example of a survey that can be used for a structured informational and the The survey asks about a variety of potential preferences interview. conditions under which a child makes his or her choices. survey, the interviewer ranks the potential reinforcers and can recommend the the interviewer ranks the potential reinforcers and can survey, specific circumstances under which they should be used. different ways to assess the preferences of children with intellectual and the preferences of children with different ways to assess approach that will work best for Choose the (I/DD). developmental disabilities or setting. a particular child Student Interview about their likes and dislikes. Interview a child and ask questions Ask questions would most like to earn. a list of choices and ask which they such as: Informational Interview (informal) questions Ask open-ended the child well. Interview a few individuals who know such as: accessed at: It is important to know which items and activities a child enjoys in order to know which items and activities a child It is important to to reinforce desirable behavior. choose the best rewards raisd.pdf. A teacher or psychologist may provide this assessment. Use multiple types Use multiple types iowahealthieststate.com/5210 for Children with Intellectual and Developmental Disabilities Disabilities Developmental and with Intellectual for Children TIP: of assessments to gather the most complete and accurate a information about preferences. child’s ASSESSMEN PREFERENCE Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 38 ou can identify the items or activities with the items or You can identify , or you may simultaneously present two items or or other professional with training. , or service provider may conduct this assessment. or service , caregiver psychologist, www.kennedykrieger.org/sites/default/files/patient-care-files/ www.kennedykrieger.org/sites/default/files/patient-care-files/ paired_ stimulus_preference_assessment.pdf single_ stimulus_preference_assessment.pdf • • Preference Assessments for Children with Intellectual and Developmental Disabilities It may take some time and energy to identify a child’s to identify a child’s It may take some time and energy the results of using effective non-food but preferences, Be sure to reassess a child’s rewards will be worthwhile. to change over as they are likely preferences periodically, time. Direct Observation Direct document and or activities of items range to a wide free access the child Give with each. the child spends how long demands Do not make any most time as preferences. child spends the which the Be sure to provide the observation. the child during restrictions on or place any objects and activities. explore different for the child to enough time A teacher, Assessment Systematic Present objects and activities to a child in a methodical way to help identify and rank a child’s preferences. For you example, may present objects and activities, in a random order one at a time, child to make a choice. activities and ask a by a Board Certified Behavior Systematic assessments should be conducted Analyst, assessments can be found at: More information about systematic Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 39 iowahealthieststate.com/5210 encourages kids to encourages kids .” Younger Children continued even healthy food, even healthy food, or ball. Frisbee, “Super Kid of the Day” or “Star of the Day “Star “Super Kid of the Day” or

Share a special item or talent with the group. Share a special item or talent with the Be Sit in a special seat during snack or mealtime. Sit in a special seat during snack or a bulletin board. Be recognized in a newsletter or on Get a signed t-shirt, Lead group activities. Receive coupons for special privileges. or have one sent Receive a positive note from the program staff or director, Attend a reading party (kids bring blankets to sit on and read favorite Read a favorite poem. Share a favorite picture of a family member or friend. Play a favorite game or puzzle. Eat snack outdoors or have a picnic. home for parents to see. books). eat when they may not be hungry and can lead to poor eating not be hungry and can lead eat when they may to reward kids without using There are plenty of ways habits. and younger kids, of the ideas on this page for Use some food. kids. for non-food rewards for older look on the back Reward for Alternatives to Food as a • • Rewarding kids with food, Rewarding kids • • • • • • • • • • • .” “You “You For example, did a great job, John. did a great job, I’m so proud of you for helping Jack with his math problems today Don’t underestimate Don’t underestimate the power of using is verbal praise that of all specific with kids ages. s NON-FOOD REWARDS NON-FOOD USE Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 40 an environment the opportunity for to fitness if physical Creates Adds Allows that fosters healthy eating that fosters and supports the 5-2-1-0 message. . more frequent rewards reward. activity is used as Benefits of of Benefits non-food providing rewards: • • • etc.). concerts, rubber balls, non-food items dances, yo-yos, etc.). Slinkys, sports games, or games). toys, school supplies, finger puppets, non-food rewards and choose a reward from the list non-food rewards etc.). stickers, water bottles, head or wrist sweat water bottles, crayons, Frisbees, bubbles,

Make a list of fun, Make a list of fun, ake a walk with a teacher or a favorite staff member. staff or a favorite a teacher walk with Take a favorite music. Dance to trophy or ribbon. Receive a that can only be used on special occasions Get access to items a treasure chest full of small, Select an item from

Earn sports equipment or athletic gear Choose brain teasers or games for the group to play. Choose brain teasers or games for the Earn certificates for music downloads. Win tickets to special events (e.g. Be entered into a drawing for donated prizes. Be entered into a drawing for donated Receive a positive note from the program staff or director. Receive a positive note from the program (e.g. NERF balls, bands, Earn points or play money for privileges. spinning tops, when appropriate. (e.g. special art supplies, special (e.g. (e.g. • • • • • • • Use Non-food Rewards Alternatives to Food as a Reward for Older Kids Alternatives to Food as a Reward • • • • • • Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 1 4 Dance Dance Revolution). Wii, ‘walk and talk’ with a special like a bike or jump rope. Dancing to favorite music. A Extra outdoor time. Setting up an obstacle course. Special access to particular toys Access to active video games A monthly physical activity person. or games that promote movement,

Helps kids get their 1 hour a day! Helps kids get their fun! Makes physical activity as they just add up to give, Won’t limit how many rewards you can event to celebrate accomplishments. more activity for kids! (e.g. • • • So next time you want to reward kids, think about how about think kids, reward to want you time next So active. physically it make could you to ideas some are Here started: you get • • • • • • Using physical activity instead of a food reward: Using physical • iowahealthieststate.com/5210

Research indicates that that indicates Research may games video active to way effective an be overall kids’ increase levels. activity physical during used Energy is play game video active moderate- to comparable walking. intensity Use Physical Physical Use REWARD A AS ACTIVITY

move! to

love kids Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 2 4 reflect Use such as to and interest, s child’ a or other professional with maintain TO to , and begin to replace food rewards with non- and begin to replace food , time psychologist, racker to gather information about how often a Tracker to gather information about . vary rewards over rewards vary and Describe the desired behaviors in observable and measurable terms. Describe the desired behaviors in observable to do to receive the reward, Specify exactly what the child needs Include a reinforcement schedule that describes when and how often Include a reinforcement schedule that correctly identifying an object in a picture or walking quietly in the correctly identifying an object in a picture hallway to use specific rewards.

Use the Food Rewards Complete the transition and avoid the use of food to reinforce desirable

food rewards and exclude any food rewards. Be sure to: rewards. food rewards and exclude any food the food rewards currently used. child is rewarded with food. food less and less frequently food rewards. Do this very gradually for the most effective results. food rewards. behaviors. Create or update the child’s Behavior Intervention Plan to include non- Behavior Intervention Create or update the child’s Complete preference assessments to identify new reinforcers to replace Complete preference assessments to the use of food as a reward. Begin the transition by slowly reducing • • • social attention By association, important to pair tangible items with praise. may become more reinforcing over time. the child’s changing preferences. the child’s Limit a child’s access to the selected rewards to increase their desirability. Limit a child’s it is still For children who may not be as motivated by social attention, Rotate 3. 4. 2. 1. 5. experience developing Behavior Intervention Plans to assist with the experience developing Behavior Intervention Plans to assist with the process. Tips for Using Non-Food Rewards: Reducing the use of food rewards can be a difficult process. Consult a Board Reducing the use of food rewards can be a difficult process. Analyst, Certified Behavioral • • • The transition away from using food rewards to reinforce behaviors may seem from using food rewards to reinforce The transition away process. Follow these are steps you can take to ease the daunting, but there approach to education rewards part of a coordinated steps to make non-food and developmental for children with intellectual and behavior management disabilities (I/DD). iowahealthieststate.com/5210 TRANSITIONING TRANSITIONING NON-FOOD REWARDS NON-FOOD Disabilities with Intellectual and Developmental for Children Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 43 iowahealthieststate.com/5210 Share this plan with Develop a plan and timeline Create or update a child’s Ensure that non-food rewards Conduct preference for reducing the use of food rewards. other members of a child’s support team. Behavior Intervention Plan to include non-food rewards and reduce any food rewards. are used consistently in a child’s education and service plans. assessments to identify which non-food rewards will work best for a child.

Board Certified Board Certified Analysts Behavior (BCBA) • • • • Case Managers is key! is

, and home settings. These professionals and home settings. , coordination community Recommend that food alk to families about the Talk to families about Reinforces the 5-2-1-0 message. Reinforces the Provides non-food rewards. Provides physical activity as a rewards be limited and/or eliminated from a child’s education and service plans. reward. reasons to avoid using food rewards at home. health care, • • • • • Everyone Health Care Providers school, request assistance Teachers Teach children about why Use the same rewards for Use non-food rewards for Share new reinforcement Create or update a child’s Conduct preference children with disabilities as the rest of the class. all children in the class. strategies with other members of support team. a child’s Behavior Intervention Plan (BIP) to include non-food rewards and reduce any food If a Board Certified rewards. Behavior Analyst or psychologist is available, in creating the plan. assessments to identify which non-food rewards will work best for a child. non-food rewards are used in the classroom. • • • • • • ARDS WARDS RE NON-FOOD Children with intellectual and developmental disabilities (I/DD) receive services from multiple (I/DD) receive services from and developmental disabilities Children with intellectual child care, professionals within the child team can play a role in helping member of a child’s Each support team. are part of a child’s and make healthy choices. develop healthy behaviors Classroom Special Education Special Education Teachers PROVIDING IN ROLE A PLAYS RYONE EVE Disabilities Developmental and with Intellectual for Children

Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 4 4

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A PHYS Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 5 4 Physical Teens and Young Activity Inclusive for (in the ‘Getting Started’ section of (in the (in the ‘Getting Started’ section of this toolkit) ‘Getting Started’ section (in the LET US Play ransition Plans to Support Healthy Habits for Transition Plans to Support Healthy INCLUSIVE ry Structured Recess

Activity Activity Physical Children with I/DD Adults with I/DD this toolkit) Children with I/DD Everyone Plays a Role in Making Physical Everyone Plays a T Zones, Stations, and Relays and Stations, Zones, Support Healthy Habit Goals for Use Education and Service Plans to Tips to Adapt Physical Activities to Include Children with I/DD Adapt Physical Tips to Activity Social Inclusion and Physical Legal Requirements for Including Children with I/DD in for Including Children with I/DD Legal Requirements Use Overcoming Barriers to Including Children with I/DD in Overcoming Barriers to Including Principles of • • • • • • • • • for children Support physical activity goals with I/DD: Learn about the laws and best practices for laws and best practices for Learn about the with I/DD in physical activity: including children • to to adapt or modify activities Get ideas for ways include children with I/DD: O TO etc. climbing, dancing, ctivity iowahealthieststate.com/5210 jumping, PHYSICAL ACTIVITY PHYSICAL is any movement that increases heart rate and breathing such as running, to make physical for activity inclusive children with intellectual and developmental disabilities (I/DD). Each bolded item represents a handout in this toolkit! Here are ideas for how Here are ideas for for Children with Intellectual and Developmental Disabilities Disabilities with Intellectual and Developmental for Children MAKE PHYSICAL PHYSICAL MAKE A HOW HOW Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 6 4 continued According to this law:

2013 (OCR) Dear Colleague Letter of Office for Civil Rights Individuals with Disabilities Education Act (IDEA) of 2004 Act Education Individuals with Disabilities Section 504 of the Rehabilitation Act of 1973 Rehabilitation Section 504 of the

disabilities are not denied an equal opportunity to participate in interscholastic athletics.” not disability are capable of—one student with a certain type of disability may be able to play a certain type of sport but another student with the same disability may be able to play that sport.” opportunity to participate.” extra-curricular athletic activities. “…work with their athletic associations to ensure students with “…(do) not rely on generalizations about what students with a type of “…(make) reasonable accommodations—to ensure (a student has) an equal All students with disabilities must be provided with physical education. All students with disabilities must be All students must have the same opportunities to engage in All students must have the same opportunities • • • These documents establish the responsibilities of physical education instructors, These documents establish the responsibilities Office for Civil Rights (OCR) Office for Civil Rights (OCR) Dear Colleague Letter of 2013 schools were not complying with Written in response to reports that disabilities the same opportunities to be requirements to offer students with The letter recommends that as physically active as their non-disabled peers. school districts: • • • Section 504 of the Rehabilitation Act of 1973 Section 504 of the Rehabilitation rights of individuals with disabilities in A federal law designed to protect the including all elementary federal assistance, programs and activities that receive and secondary public schools. • The following three documents govern the inclusion of children with intellectual documents govern the inclusion The following three disabilities (I/DD) in physical activity. and developmental • extra-curricular activity providers, and recreation providers. By becoming providers. and recreation extra-curricular activity providers, school districts can ensure requirements, familiar with them and meeting their opportunities to be physically active as that children with I/DD have the same their typically developing peers. you are not iowahealthieststate.com/5210 By including children By including children with I/DD in physical activity, only following the law only following the raise —you are helping teach healthy kids and lifelong healthy habits! LEGAL REQUIREMENTS LEGAL and with Intellectual Children for Including Activity Physical in Disabilities Developmental Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 7 4 Asked Frequently 2016. 2016. . Office of the Assistant Secretary. Office of the . Department of Education. Accessed on July 5, U.S. Accessed on July 5, 2016. idea.ed.gov. Protecting Students with Disabilities, Protecting Students with Disabilities, The Legacy of IDEA 2004. Building According to this law: According

About Section 504 and the Education of Children with Disabilities. About Section 504 and the Education Department of Education Office for Civil Rights (OCR). Department of Education Office for Civil Rights (OCR) Dear Colleague Letter Department of Education Office Department of Education. education. environment.” “least restrictive in the public education” Physical education is a requirement for students who receive special is a requirement for students who Physical education Schools are required to provide students with a “free and appropriate “free a students with required to provide Schools are Legal Requirements for Including Children with Intellectual and Developmental Disabilities in Physical Activity Legal Requirements for Including Children with Intellectual and Developmental • U.S. U.S. http://www2.ed.gov/about/offices/list/ocr/letters/colleague-201301-504.pdf. • Individuals with Disabilities with Disabilities Individuals of 2004 Act (IDEA) Education of students educational needs schools to serve the law that requires A federal with disabilities. Accessed on July 5, www2.ed.gov/about/offices/list/ocr/504faq.html. Questions U.S. Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 8 4 continued an extra For example, whenever possible. and stay focused. ACTIVITIES Emphasize teamwork over speed and accuracy. Give every child an equal chance to play. Rotate teams so that skill levels are balanced. Give a child more “tries” than are normally permitted. Give a child more Use peer partners to model activities and social skills. Use peer partners to model activities Show videos of activities in advance, brief. Keep verbal instructions specific and the instructions before beginning Check to make sure all children understand Allow children to play with partners. Let children recommend their own modifications to the rules. Create and post routines. For example: Create and post routines. make choices, to help children such as photo activity cards, Use a visual aid, Define boundaries and targets using colored tape or spots. Define boundaries and targets using e Cool Down Clean Up Warm Up Practice Skills Play Gam understand expectations, the activity. shot in basketball or an extra pitch in softball. • • • • • • • • • • • • • Play games that emphasize cooperation rather than competition. Change the rules of some games to give each child a Change the rules of some games chance to succeed. Provide clear instructions. Use visual aids. Children with intellectual and developmental disabilities (I/DD) need one and developmental disabilities Children with intellectual typically developing peers. just like their each day, hour of physical activity require some with I/DD in physical activity may Including children tips for making some examples of adaptations and Here are adaptations. for children with I/DD. physical activity inclusive Demonstrate activities. ADAPT O TO

Learn about a child TIP: Learn about a child by reading their Individualized or Education Program other by speaking with to adults in their life determine which adaptations will help the child participate. TIPS TIPS PHYSICAL to Include Children with Intellectual and Developmental and Developmental with Intellectual Children to Include Disabilities Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 49 and , and relays smaller , Typically PE stations, stations, bigger , some children may heavier , and rackets in lighter and heavier sticks, o learn more about Adapted Physical Education visit: Adapted Physical Education visit: To learn more about

Provide private or gender neutral changing areas for children who may have gender neutral changing areas for Provide private or aides of a different gender. aides of a different and padded handles to make them easier to hold. weights,

Relays’ handout). Stations and ‘Zones, (see the music and yelling. audible (with bells inside). throughout a school district and community. Offer equipment such as bats, lighter, Offer many different kinds of balls - Provide enough space to accommodate a wheelchair. Provide enough space Define the boundaries of a playing area by using zones, by using area of a playing the boundaries Define nets as needed. height of goals or Lower the equipment. away unnecessary distractions by putting Minimize loud to sounds by avoiding are sensitive for children who Reduce noise Establish an equipment bank so that modified equipment can be shared Establish an equipment bank so that • • • • • • • • • Federal law requires that children with disabilities be Federal law requires that children (PE) at school. provided with physical education support in order to benefit from require more individualized PE. www.heartlandaea.org/special-education/special-education- services/ape Modify equipment to accommodate all abilities. Modify equipment Ensure that changing rooms, locker rooms, and rooms, locker rooms, Ensure that changing accessible. bathrooms are adaptations to ensure a child instructors can make simple However with a disability is included. Adapt the environment to promote inclusion. promote to the environment Adapt Tips to Adapt Physical Activities to Include Children with Intellectual and Developmental Disabilities Tips to Adapt Physical Activities to Include Children with Intellectual and Developmental Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care if 0 5 give the For example, “Please walk.” rather “Please walk.” For example, Say if an instructor says “Run home!” if an instructor says “Follow directions” and “Take turns.” “Take “Follow directions” and For example, if it is time to put away equipment and a child if it is time to put away equipment and Many children with I/DD can be very concrete in BARRIERS Say things like For example, give the child a choice of clean-up tasks. Service Plan (IFSP) to determine whether the child has any Service Plan (IFSP) to determine whether “Don’t run.” Do not ask a child if they want to do something when there is no real choice. Give positive directions rather than negative directions. Do not assume a child will know to complete a step unless you tell them to. Do not assume a child will know to complete a step unless you tell them Pause for at least 5 to 7 Allow enough time for a child to process instructions. Avoid using jargon or slang. Offer clear instructions. Clearly explain rules and expectations around behavior before an activity begins. Clearly explain rules and expectations own solution to a problem. Allow a child to come up with their Direct a child who needs a break to an individual activity. an individual activity. Direct a child who needs a break to Provide choices. than their interpretation of language. a child may take off running toward their house. during a softball game, time for warm-ups.” “It’s “Do you want to do your warm-ups?” say Instead of, child 5-10 minutes to spend on a stationary bike kept close to the activity area child 5-10 minutes to spend on a stationary before returning to the group activity. seconds before restating an instruction or giving a new one. Family behavior or communication challenges. and use those same strategies with the child. and communication strategies, wandering off. they ask the child how for them to play, the child disrupts a game that is hard would change the rules to make it easier. refuses to help, ized Individualized Education Program (IEP) or Individual Review a child’s Ask other members of a child’s team about effective behavior management team about Ask other members of a child’s as a risk of such behavior poses any safety concerns, Find out if a child’s • • • • • • • • • • • • • Tips for Effective Communication Tips for Behavior Management Children with intellectual and developmental disabilities (I/DD) sometimes and developmental disabilities Children with intellectual with When encountering a child communication challenges. have behavioral or that child in instructor may not know how to include an these challenges, effectively communicate some tips to manage behavior and Here are activities. can be included in physical activities. so that all children Tips General VERCOMING VERCOMING iowahealthieststate.com/5210

O to Including Children with Intellectual and Developmental Developmental and with Intellectual Children to Including Activity in Physical Disabilities

positive!

e th on focus Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 51 activity and collaboration in the activities they can create conditions that they can create conditions Here are some tips to make Here are some tips cooperation, Include social skill development in lesson plans and Include social skill development in inclusive. Praise and reward children for being Establish a buddy or mentoring system. Play games in which everyone has opportunities to be both a helper and Emphasize the values of respect, by planning some activities where they can strengths Emphasize each child’s or to have special responsibilities. Give each child opportunities to lead Plan activities that promote cooperation and teamwork over competition and Plan activities that promote cooperation each child in your program or class. Demonstrate that you enjoy having “no tolerance” rule for bullying. Establish a such as cutting students from team sports. Lobby against exclusionary policies, activities. to be helped. demonstrate their skills or sports knowledge. you lead. winning. Make relationships a priority. • • Use peers as a resource. • • • social standing. Build a child’s • • Children are more likely to participate in group activities when they feel likely to participate in group activities Children are more While physical education teachers, by their peers. accepted and included • • • • leaders, and coaches cannot force friendships, and coaches cannot leaders, inclusive. activities more socially Be a role model. foster positive relationships among children. foster positive relationships iowahealtheststate.com/5210 There are programs There are programs designed specifically to empower people I/ with and without DD to participate together in sports. One example is Unified Sports, a program of Special Olympics. Learn more and get involved: www.soiowa.org/ special-programs/ unified-sports/ SOCIAL INCLUSION INCLUSION SOCIAL ACTIVITY PHYSICAL AND Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 2 5 continued Here are board the hoop height may motions one zone may allow Bouncing balls Push Punching bags Planks Dips Push ups Fast clapping Jumping jacks Balance Arm circles • • • • • • • Examples of Stations: • • • For example, and relays to plan fun activities and relays to plan or color coding stations so children For example, stations, Direct children to different zones based on Direct children to different zones based lettering, and relays are great for meeting the physical and relays are great ou may also code stations by level of difficulty. You may also code stations by level of difficulty. stations, Try numbering, S Basketball Using Zones TIONS, TIONS, A Y Divide the court into zones using tape or cones. Divide the court into zones using tape “wheelers” and one for one for walkers, runners, one for Create 3 zones: Change the set-up in each zone as needed. Establish different rules for each zone. (children in wheelchairs or on scooter boards). (children in wheelchairs or on scooter vary between zones. while another zone only allows 2 tries. 5 tries to shoot a basket, • • • • Station Games Allow children activity at each location. with a different Set up multiple stations, but to skip any station they are not to rotate from one station to the next, comfortable with. know where to go next. activity needs of all children. These types of games create defined boundaries to These types of games create children. activity needs of all spaces like open gyms who get overwhelmed by large accommodate children groups to ensure everyone is active. They divide children into smaller and fields. to participate. for children of varying skill levels And they make room how to use zones, some examples of that include all children. Zone Games Divide a large play area into zones. Games that use zones, Games that use zones, ability level or some other criteria. Example: RELA iowahealthieststate.com/5210 ZONES, ST ZONES, AND Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 3 5 , and to , Make sure to emphasize Make sure www.nchpad.org/fppics/ Create the same Provide an active task that task an active Provide etc. 2016. Activity and Disability (NCHPAD) 2015. Physical cones for more of a challenge. cheers them on. alongside the person with the ball and doing push ups or jumping jacks, must keep moving by jogging in place, etc. number of lines of cones as you have teams. number of lines of who does the same. and then passes the ball to a teammate hop with the ball between with their feet, They may dribble use their hands. their feet, wheel with the ball between their legs, down the line of cones.

have the most cheering for your team members. have the most cheering for your team Children may move the ball in a straight line, or back and forth between line, Children may move the ball in a straight runs/wheels “enthusiast” who “cheerleader” or Each team may elect a for their teammate to return the ball, while waiting The rest of the team, Give each team a soccer ball. Give each team a soccer line of cones. one end of their team’s Children line up at ball to the end of the line and back, A child from each team moves the soccer do not as long as they that they choose, Children may move the ball any way have dribbled the ball up and A team has finished once all team members field in the most creative way The goal is to move the ball across the Set up lines of cones on a field or in a gym. Set up lines of cones into teams of 3 or more children. Split up the group Adapt • • • • Play • • • • • • • Zones, Stations, and Relays Discover Inclusive Physical Education, A Guidebook for Physical Educators. Published A Guidebook Adapted with permission from Discover Inclusive Physical Education, by the National Center on Health, Discover%20 Inclusive%20Physical%20Education-Final.pdf. Accessed July 5, Discover%20 Inclusive%20Physical%20Education-Final.pdf. Relays teams. into smaller children group of a large Break and winning. rather than competition teamwork Ball Relay Soccer Example: Set Up each child must complete before the group is finished. the group is must complete before each child Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care . 4 5 To help or gym into areas for , and Simon Says during , field, soccer basketball,

try organizing structured recess! try organizing structured or volunteers to act as “recess coaches,” or volunteers to act as staff, many children are not as active as they could be during recess. not as active as they could be during many children are Encourage teachers, Create boundaries that divide the playground, Play games such as four square, Students can engage in physical activity regardless of skill level. Students can engage in physical activity in physical education class. Students practice motor skills taught and encouragement. Students receive targeted instruction coaching from adults. Students can practice social skills with conflict resolution. Supervision ensures safety and healthy who need more time to learn. Adults explain game rules to students structured recess. lead activities, and provide supervision during recess. and provide supervision lead activities, structured activities and free play. • • • • • • • • • Ideas for structured recess: However, However, from recess, all children benefit Active play during recess helps children get 1 hour of physical activity each day recess helps children get 1 hour of Active play during recess? What is structured Benefits of structured recess: Structured recess is based on the principle of structured play which involves is based on the principle of structured Structured recess and led by adults. physical activities and games taught a STRUCTURED RECESS! STRUCTURED ou may also Y Y Try teaching iowahealthieststate.com/5210 Structured recess is Structured recess for especially helpful including children and with intellectual developmental in disabilities (I/DD) group play during recess. TR child with I/DD the games ahead of time so they are familiar with the rules. match a child with I/ DD with a peer helper to play games with during recess. Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 5 5 continued and rules equipment, pace, S Elimination ninvolved staff and kids involved U y ry the simple game modifications using LET US Play that are found on the ry the simple game modifications using Getting Removing Lines T back of this page. posters for more information on how Check out the LET US Play videos and Play principles to enhance the games program leaders can use the LET US how to play. children love and staff already know www.p2yp.org/training/get-kids-active/let-us-play-videos www.p2yp.org/training/get-kids-active/let-us-play-posters Eliminating Reducing Team size Being creative with The allow staff to iowahealthieststate.com/5210 Principles of Principles LET US Pla US LET LET US Play is an easy-to-use set is an easy-to-use maximize of techniques to the amount of physical while activity all kids get playing games. techniques modify the games kids love to ensure everyone has a chance to join in. LET US Play Principles were developed by Policy to Practice in Youth Learn Programs (P2YP). more at: www.p2yp.org/training/ get-kids-active Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 6

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ATIONS MODIFIC POSSIBLE two 5 v 5 games) Fielding team performs a task as a group — Make these changes to help get uninvolved kids involved Make these changes to help get uninvolved Make these changes to help get uninvolved kids involved Remove goal keepers and reduce the size of the goals Remove lines by modifying the type of relay race (e.g. teams start teams start of relay race (e.g. of relay race (e.g. Remove lines by modifying the typeRemove lines by modifying the type different equipment and ways of moving) use different equipment and ways of moving) use and finish in center, and finish in center, — — Decrease number of kids on each team Decrease number of kids on each team kids involved Make these changes to help get uninvolved kids involved Make these changes to help get uninvolved size of the goals Remove goal keepers and reduce the size of the goals Remove goal keepers and reduce the — — 10 v 10) into two smaller games Split one large game (e.g. (e.g. — Have kids who are tagged become additional chasers — Make these changes to help get uninvolved kids involved Kids perform an active task when tagged Every game starts with multiple taggers Entire kicking team runs the bases together the bases team runs kicking Entire can the kicking team number of RUNS OUTS count the Instead of time given amount of score in a two separate games groups of kids into Split large kids involved lp get uninvolved Make these changes to he as a group Fielding team performs a task Have players switch sides when they are tagged with the ball sides when they are tagged with the Have players switch Split a large game into two smaller games Split a large game S S S S L L L L E E E E E L T T T T U U U U S U T Kicker Start and DESCRIPTION One or more “chasers” attempt to “tag” or touch other players. Each tagged participant is eliminated. finish at one side of the activity area. 2 teams. 10 v 10. Goalkeepers on each team. Kids in teams of 6 or more. Kids wait in line for turn. 2 teams and (kicking fielding). runs bases. Kicker eliminated if player/base is tagged or if ball is caught by fielding team. 2 teams. If child is tagged with the ball or if the ball is caught they are eliminated from the game. Tag Relay GAME Races Soccer Games Dodgeball Kickball Principles of LET US Play Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 57 and iowahealthieststate.com/5210 Ensure all children engage Adapt and modify activities Help physical education Use inclusive strategies to posture, Address a child’s Provide opportunities for all in active recess. to include all children. mobility needs. teachers understand how to adapt the PE curriculum to special needs. meet a child’s involvement promote a child’s in physical activity. muscle strength, children to be physically active by incorporating motor breaks into lessons. • • • • • • Child Care and Out-of-School Providers Therapists Physical Special Education Special Education Teachers INCLUSIVE INCLUSIVE , and home settings. These professionals and home settings. ,

community

is key! is coordination Reinforces the ‘5-2-1-0’ message. Reinforces the Provides opportunities for Acts as role models by being Help children who have trouble physical activity every day. physically active. with social skills to increase participation in group physical activities. health care, • • • • Everyone Speech and Language Speech and Language Pathologists ACTIVITY school, Make sure a child’s team Make sure a child’s Ensure alignment of physical Request services that promote Help evaluate children to Talk to families about the Adapt and modify Recommend physical Recommend physical activity addresses the child’s physical addresses the child’s at school, activity goals at home, and in the community. activity goals in a child’s education and service plans. physical activity when sedentary behavior interferes with a child’s physical or mental health. and service plans. determine if they require Adapted Physical Education (APE) services. activities to include all children. education goals for each education plan. child’s goals for a child’s education goals for a child’s importance of physical activity. • • • • • • • • Children with intellectual and developmental disabilities (I/DD) receive services from multiple (I/DD) receive services from and developmental disabilities Children with intellectual child care, professionals within helping the child team can play a role in member of a child’s Each support team. are part of a child’s and make healthy choices. develop healthy behaviors Case Managers Health Care Providers Physical Education Physical Education MAKING IN ROLE A PLAYS RYONE EVE for Children with Intellectual and Developmental Disabilities Developmental and with Intellectual for Children Teachers SICAL YSICAL PH

Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care

8 5

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living, Teens and active 5-2-1-0 Healthy Choices Count! Health Definitions for Children with I/DD 5-2-1-0 Healthy Choices Count! THY HABITS THY Support Healthy Habits for * Healthy Choices Count! Health Care Healthy Choices Activity’ tab) www.iowahealthieststate.com/5210 * . Tips for Communicating with Children with I/DD* Tips for Communicating with Children 5-2-1-0 ‘Physical Transition Plans to Resources: alk respectfully with patients about healthy eating, alk respectfully with

Patients with I/DD Habit Goals Goals DD DD* Health Care Challenges for Children with I/DD* Health Care Challenges for Children Healthy Habit Challenges for Children with Specific Disabilities* Healthy Habit Challenges for Children Healthy Habit Challenges for Children with I/DD* Healthy Habit Challenges for Children 5-2-1-0 Healthy Choices Count! Use Legal Requirements for Including Children with I/DD in Physical Activity Services for Children with I/DD* Goals Support Healthy Habit Use Education and Service Plans to with I/DD (in the Children with I/DD T Connect to the community and Connect to the community Review Recommend Healthy Habit Goals for Education and Service Plans for Education Goals for Recommend Healthy Habit Services to Healthy Habits for Patients with I/ Support Make Referrals for Coordinate Services to Support Healthy Outcomes for Children Health Care Provider Statement Recommending Healthy Healthy Habit Statement Recommending Sample Health Care Provider community efforts. and older weight. Assess a patient’s height and weight, and measure BMI for children age 2 and measure BMI for children age height and weight, Assess a patient’s Become familiar with services, legal requirements, Become familiar with services, for children with I/DD: and the special education process • • • Understand the additional challenges children with I/DD face with regard to eating healthy foods, and accessing health care: being physically active, • • • • • • • • • • Care For more information, check out the For more information, • • • • Collaborate with a child’s support team using Collaborate with a child’s these handouts: Use the those with I/ including all pediatric patients, strategies with DD: *These tools can be found in the ‘Getting Started’ tab of this toolkit. O TO OCATE HEAL VOCATE iowahealthieststate.com/5210 Here are some ways to Here are some ways habits advocate healthy for children with intellectual and developmental in disabilities (I/DD) the health care setting. Each bolded item represents a handout in this toolkit! AD HOW HOW for Patients with Intellectual and Developmental Disabilities Disabilities Developmental and with Intellectual for Patients Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 0 and 6 and continued and Teens ‘5-2-1-0 Healthy Goals

y it services, Activ so the professionals working for transition needs based ical our advice will go a long way! Y hys Education Program (IEP), and (IEP), Education Program nd P a ized ng handout in the ‘Getting Started’ section of this ‘Getting Started’ section handout in the

Eati handout in the ‘Getting Started’ section of this handout in the althy e H d ransition Plans to Support Healthy Habits for Transition Plans to Support Healthy n reatment Plan (ITP), include goals, Treatment Plan (ITP), e m m screen time, or sugary drinks. screen time, Talk to patients about how to be responsible for their own health,

, Adults with I/DD’ eco R oung Education and service plans are referred to throughout the year, so progress Education and service plans are referred to throughout the year, Health care providers are trusted and respected by families and the profes- Education and service plans are legal documents, hy Recommend goals for education and service plans that align with goals Recommend goals for education and physical rewards, non-food eating, Add any other goals related to healthy Support Healthy Habit Review the ‘Use Education and Service Plans to Review the ‘Use with a child with I/DD will be sure to work toward the goals outlined in these with a child with I/DD will be sure to work toward the goals outlined in documents. toward goals will be tracked. sionals who make up a child’s support team. sionals who make up a child’s Y on the individual's disability. toolkit. identified through your conversation with patients using the identified through your conversation Habits Questionnaire." activity Goals for Children with I/DD’ recommend healthy eating and active living goals toolkit to learn more about how to write goals for each toolkit to learn more about how to write type of plan. Individualized Education and service plans, including the Individualized Family including the plans, Education and service Individual Service Plan (IFSP), and developmental for children with intellectual accommodations and supports provided Goals, services, disabilities (I/DD). of the child's must be based on need as a result through an IEP and Appropriate Public disability in order to ensure a Free Education (FAPE). • • • W • • • • What to Do iowahealthieststate.com/5210 Adding goals related to Adding goals related healthy eating and a physical activity to and education child’s that service plan ensures the child receives appropriate services to address their needs. Health care providers can play an important role by recommending goals to include in these plans. Health care providers should remind families that their recommendations should be considered by the IEP team but are not required for the team to adopt. for Education and Service Plans for Patients with Intellectual with Intellectual and Service Plans for Patients for Education Disabilities and Developmental

RECOMMEND HEALTHY HABIT GOALS HABIT HEALTHY Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 1 6 Goals Activity Activity and Physical Physical and Healthy Eating Eating Healthy for Education and Service Plans for Patients with Intellectual and Developmental Disabilities ‘Health Care Provider Statement Recommending Healthy Habit Recommending Provider Statement ‘Health Care Write a statement and give it to a child’s parents or caregivers to share parents or it to a child’s and give Write a statement Recommend Recommend to Build relationships with other team members and play an active role with other team members and play Build relationships Use the support team other members of a child’s Attend meetings with in developing education and service plans. in developing education whenever possible. Goals.’ team. of the child’s with the rest • • • How How Recommend Healthy Habit Goals Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care

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velopment, or education: velopment, de ’s health, ______Additional Assessment: or Additional f ______How the diagnosis impacts the child the diagnosis impacts How Date of Birth: Diagnosis: ______Suggested Accommodation at School: ______of School and at Home: Suggested Accommodation Outside ______Recommendation ______Signature: Provider Patient’s Name: Name: Patient’s ______and/ TEMENT RECOMMENDING ATEMENT out-of-school, iowahealthieststate.com/5210 Health care providers Health care providers to may use this form related recommend goals and to healthy eating active living for children. list Providers should suggested goals for school, or home settings and give parents or it to the child’s caregiver. Copies of completed forms can also be saved in chart for the patient’s future reference. PROVIDER CARE HEALTH ST HEALTHY HABIT GOALS HABIT HEALTHY Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care

___ offered 63 ______or education: ______be assessed for an oral ______ducing Ashley to new healthy development, tables at lunch each day. athologist to Non-food rewards, especially active play ices at lunchtime and ensure she is fruits ms if she does not start eating more plan for intro . Assessment: School: providers should avoid giving

at vice

______Additional for

Ashley B. Ashley 8/13/10 pre-diabetes syndrome, Obesity, Down ______: ______

______and vegetables and less candy. ______Suggested Goal/Service/Accommodation Outside of School and at Home: Parents, caregivers, and ser Recommendation motor delay and to develop a treatment foods despite her oral-motor challenges. ______time, should be used instead. Ashley is at risk for serious health proble ______Accommodations Suggested cho Ashley needs an adult to monitor her of vege at least 1 serving of fruit and 1 serving Ashley candy to reward good behavior Ashley should see a PSpeech and Language health, How the diagnosis impacts the child’s Patient’s Name: ______Name: Patient’s Date of Birth Diagnosis: Catherine Jones, FNP e:

TEMENT RECOMMENDING ATEMENT iowahealthieststate.com/5210 PROVIDER CARE HEALTH SAMPLE ST GOALS HABIT HEALTHY Provider Signatur Table of Contents Getting Started Healthy Eating Non-Food Rewards Physical Activity Health Care 64 Worker Therapist and/ Therapist orker W Here are some common Here are some REFERRAL REFERRAL Physical Therapist, Physical Occupational and/or Recreation and/or HABITS , , , Early intervention is key to promoting FOR SERVICES SERVICES FOR Worker Physical Educator Therapist or Recreational Physical Educator and/or Speech and Language Pathologist Speech and Language Pathologist and/or Social Social Physical Educator Physical Educator Physical Educator and/or Social Physical Educator Registered Dietician, Occupational Therapist, and/ Registered Dietician, Occupational Therapist, or Speech and Language Pathologist and Occupational Therapist and/or Speech Language Pathologist Therapist Occupational Psychologist Board Certified Behavior Analyst and/or Psychologist Board Certified Behavior Analyst and/or Occupational Therapist and/or Speech and Occupational Therapist and/or Speech Language Pathologist LTHY HEA SUPPORT HEALTHY EATING CHALLENGES iowahealthieststate.com/5210 PHYSICAL ACTIVITY CHALLENGES ACTIVITY PHYSICAL O Not meeting daily recommendation for physical activity Difficulty finding an inclusive after school program Tires easily during physical activity by physical activity Over-stimulated Exaggerated fear of injury during physical activity Delayed motor skills impacting activity level Delayed motor skills impacting activity Difficulty understanding game rules Social skill deficits that prevent involvement in group activity Poor posture that interferes with sitting and with eating Poor posture that interferes with sitting day Seeks unhealthy snacks throughout the meal times Challenging behavior during snack and Sensitivity to food tastes and textures Highly selective eating Low muscle tone around the mouth T Some of these challenges may not seem major, but it is important for health care providers to take seriously any Some of these challenges may not seem major, barrier a patient experiences to eating healthy or being physically active. healthy behaviors for children with I/DD. for Patients with Intellectual and Developmental Disabilities Developmental and with Intellectual for Patients ERRALS ERRALS REF MAKE Children with intellectual and developmental disabilities (I/DD) often have different needs disabilities (I/DD) often have intellectual and developmental Children with but a needs, expected to address all of these No single provider is diagnoses. related to their and be able to familiar with available services care provider should become health child’s address challenges. to professionals who can help refer a patient challenges and the type of professionals who can help address them. the type of professionals who challenges and