NOW SERVING: DEVELOPMENTAL DISABILITIES DEMYSTIFYING A NEW POPULATION A presentation for the Region 10 Autism Conference July 30, 2016 Developed By Emily Helmb o ld t , LBA, BCBA, LPC VCU Autism Center for Excellence Presented by Justin Creech, PBSF and Darcy Creech, PBSF PARTICIPANT OBJECTIVES 1. Be familiar with the federal definition of developmental disabilities. 2. List at least 3 developmental disabilities 3. List the 3 most common developmental disabilities 4. Have a better understanding of required supports for various developmental disabilities WHO’S HERE? LET’S REVIEW SOME POINTS BRIEF HISTORY OF WAIVERS Waiver services first began in early 1991 through what was known as the Mental Retardation Waiver. This was eventually renamed the Intellectual Disabilities (ID) Waiver. The Individual and Family Developmental Disability Waiver (IFSDD/DD) was established in 2000 to serve individuals with Developmental Disabilities not meeting the diagnostic criteria for the ID Waiver The Day Support Waiver was started in 2005 to allow individuals on the Statewide Waiver waiting list at least day support services while continuing to wait on the Statewide Waiting list for services. Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 WHAT IS THE OFFICIAL VIRGINIA APPROVED DEFINITION OF DD? Federal definition developed by the AAIDD: "Developmental disability" means a severe, chronic disability of an individual that (i) is attributable to a mental or physical impairment, or a combination of mental and physical impairments, other than a sole diagnosis of mental illness; (ii) is manifested before the individual reaches 22 years of age ; (iii) is likely to continue indefinitely; (iv) results in substantial functional limitations in three or more of the following areas of major life activity: self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living, or economic self-sufficiency; and (v) reflects the individual's need for a combination and sequence of special interdisciplinary or generic services, individualized supports, or other forms of assistance that are of lifelong or extended duration and are individually planned and coordinated. DD DEFINITION CONTINUED An individual from birth to age nine, inclusive, who has a substantial developmental delay or specific congenital or acquired condition may be considered to have a developmental disability without meeting three or more of the criteria described in clauses (i) through (v) if the individual, without services and supports, has a high probability of meeting those criteria later in life. Also, Traumatic Brain Injury incurred up to age 22 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 SUPPORTS INTENSITY SCALE Supports Intensity Scale Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 SIS LEVELS LEVEL 1 Score 116 or more Less impact Level 2 Score 100-115 Level 3 Score 85-99 Level 4 Score 84 or less More impact Intermittent Limited Extensive Pervasive Source: DBHDS, My Life, My Community: Waiver Redesign Informational Series for Providers, Presentation Powerpoint, 4/1/2016 FACTS ABOUT DEVELOPMENTAL DISABILITIES Over 6 million people have a developmental disability 15% of children in the US ages 5 to 17 have one or more developmental disabilities. Autism is a developmental disability Intellectual Disability is not necessarily a developmental disability (Look at areas of functioning…) TRENDS IN DD 1997-2008 CDC and HRSA study of 119,367 children ages 3–17 found: Increased 17% over this period Prevalence of autism increased 289.5% Prevalence of ADHD increased 33.0% Prevalence of hearing loss decreased 30.9%. EXAMPLES OF DEVELOPMENTAL DISABILITIES Cerebral Palsy Fragile X Fetal Alcohol Syndrome Learning disabilities Hearing loss Autism Visual impairment Attention Deficit Hyperactivity Disorder Spina bifida Intellectual Disability Downs Syndrome Brain Injury MOST COMMON DEVELOPMENTAL DISABILITIES As of 2014, according to the Centers for Disease Control: Intellectual Disabilities 1 in 120 Cerebral Palsy 1 in 323 Autism Spectrum Disorder 1 in 68 children . (1 in 42 boys and 1 in 189 girls) . What about Down Syndrome?? 1 in 1000 THREE MAIN CRITERIA originated at birth or during childhood is expected to continue indefinitely substantially restricts the individual's functioning in several major life activities. DD DETERMINATION ID- Psych Eval Cerebral Palsy- Medical Evaluation Autism- Pediatrician, Diagnostic Clinic, Developmental Ped, etc. Down Syndrome- Pediatrician, Geneticist, etc. How to determine: “substantial functional limitations in three or more of the following areas”? . Vineland Adaptive Behavior Scales . Other adaptive behavior scales 2 TYPES OF DD ELIGIBILITY NEEDED Diagnostic eligibility Functional eligibility . Disability diagnosis . Virginia Individual Dev . Adaptive Behavior Disability Eligibility Survey Assessment “VIDES” . Vineland . DABS (in development) . Adaptive Behavior Assessment System (ABAS) . Adaptive Behavior Evaluation Scale (ABES) – similar to the ABAS, but used only for children . Scales of Independent Behavior-Revised (SIB-R) ADAPTIVE BEHAVIOR ASSESSMENT Conceptual skills—language and literacy; money, time, and number concepts; and self-direction Social skills—interpersonal skills, social responsibility, self - esteem, gullibility, naïveté (i.e., wariness), social problem solving, and the ability to follow rules, obey laws, and avoid being victimized Practical skills—activities of daily living (personal care), occupational skills, healthcare, travel/transportation, schedules/routines, safety, use of money, use of the telephone VINELAND Covers the full spectrum of adaptive behavior Three domains— . Communication, . Daily Living Skills, . Socialization . correspond to the three broad domains of adaptive functioning specified by the American Association on Intellectual and Developmental Disabilities and by DSM-5. QUALIFICATIONS TO ADMINISTER VINELAND II QUALIFICATION LEVEL B: A master's degree in psychology, education, occupational therapy, social work, or in a field closely related to the intended use of the assessment, and formal training in the ethical administration, scoring, and interpretation of clinical assessments. OR Certification by or full active membership in a professional organization (such as ASHA, AOTA, AERA, ACA, AMA, CEC, AEA, AAA, EAA, NAEYC, NBCC) that requires training and experience in the relevant area of assessment. OR A degree or license to practice in the healthcare or allied healthcare field. OR Formal, supervised mental health, speech/language, and/or educational training specific to assessing children, or in infant and child development, and formal training in the ethical administration, scoring, and interpretation of clinical assessments. DIAGNOSTIC ADAPTIVE BEHAVIOR SCALE “DABS” In development by AAIDD Comprehensive assessment of adaptive behavior CLOSER LOOK AT THE TOP 3 Intellectual Disability . Intellectual disability is a disability characterized by significant limitations both in intellectual functioning (reasoning, learning, problem solving) and in adaptive behavior, which covers a range of everyday social and practical skills. This disability originates before the age of 18. HOW IS ID DIAGNOSED? . Measurement of IQ Stanford-Binet, Wechsler, Woodcock Johnson . Measurement of Vineland Adaptive Behavior Adaptive Behavior Scale, Woodcock Johnson Scales of Ind Behavior, Diagnostic Adaptive Behavior Scale AUTISM SPECTRUM DISORDER Characterized, in varying degrees, by difficulties: . social interaction . verbal and nonverbal communication . repetitive behaviors. SPECTRUM- varying levels of impact, functioning, comorbidity LEVEL OF AUTISM Level 1 . Requiring support Level 2 . Requiring substantial support Level 3 . Requiring very substantial support WHY ALL THE TALK OF AUTISM?? FASTEST growing developmental disability in world The cost of lifelong care for someone with Autism can be reduced by 2/3 with early diagnosis and intervention Persons with ASD have poorer community integration and employment outcomes than any other developmental disability. HOW IS AUTISM DIAGNOSED? MCHAT (Modified C h e c k l i l s t for Autism in Developmental Screening Toddlers) 16 - 3 0 m o n t h s CAST - (Childhood Autism Spectrum Test) - 4 -1 1 Comprehensive Diagnostic y e a r s , “ A s p er g e r s ” idendification Evaluation CARS (Childhood Autism Rating Scale): For > 2 yrs. old; 15 - item, direct observation; 5 - 10 . Multidisciplinary m i n u t es . Developmental ADOS (Autism Diagnostic Observation Schedule): For toddlers to adults; direct Pediatrician observation, 30 - 4 5 m i n u t es . Pediatric Neurologist ADI - R (Autism Diagnostic Interview): For mental age > 2 yrs.; structured interview; 1.5 . Geneticist – 2.5 hours. Best for older . Audiologist adolescents/adults. GARS(Gilliam Autism Rating Scale) 3 to 22 . Developmental y