Tuesday, May 21, 2019

Research Opportunity for Adults who Use Wheelchairs Full-Time

Study title: Falls and Fear of Falling in Adults who Require Wheelchairs for Locomotion

To participate you must be an adult who:

  • Is at least 18 years old
  • Has a neurological diagnosis (such as but not limited to post-polio syndrome, spinal cord injury, multiple sclerosis) for at least 6 months.
  • Use a wheelchair (manual or power) at least 75% of your mobility time inside your home and 100% of the time outside your home.
  • Has a computer with internet access.
  • Is able to read and understand English.

If you are interested in completing an anonymous on-line survey about your medical condition, falls, risk of falling, and fear of falling, please access this link: https://www.psychdata.com/s.asp?SID=183112

It will take you up to about 20 minutes to complete it. People who complete the survey will be eligible for a drawing for a $20 gift card.

Principal investigator and contact person:
Carolyn (Kelley) Da Silva, PT, DSc

Carolyn is a professor in the School of Physical Therapy at Texas Woman's University and physical therapist at the post-polio out-patient clinic at TIRR Memorial Hermann Rehabilitation and Research in Houston, Texas.

Monday, May 13, 2019

Understanding a Functional Behavior Assessment


Share Article Menu

Functional Behavior Assessment (FBA)

School expectations include a lot more than just good grades. Behavior at school is a fundamental component of “academic success.” A Functional Behavior Assessment (FBA) is used to determine why a student has particular unwanted or inappropriate behaviors — understanding the triggers and reasons behind behaviors is an essential first step toward changing those behaviors.

When to Request

Is your child struggling to follow the school’s behavior guidelines? Is he getting in trouble frequently at school? Are the school’s tactics used to address problem behaviors ineffective? Is your child experiencing a lot of school-related stress? If so, it’s time to request a Functional Behavior Assessment.

How to Request

Here’s a sample letter you can use as a template when writing your own letter to request a FBA.
Dear [name of Special Education Director]:
My child, [full name and student ID# or date of birth] attends [school name]. [child’s name]’s behavior is beginning to interfere with his/her ability to learn and meet expectations. Here are the reasons for my concern:
[List your specific behavior concerns, such as]
  • He/she does not know how to appropriately manage emotions.
  • He/she flees the classroom when stressed or overwhelmed.
  • He/she is frequently hitting peers.
  • He/she is avoiding classwork.
  • He/she is disruptive when finished with classwork.
  • He/she tears up papers when frustrated.
  • He/she talks too much during class.
Please conduct  a functional behavior assessment (FBA) for [child’s name]’s, under the requirements of the Individuals with Disabilities Education Act (IDEA). This letter serves as my formal request and grants consent for the school to conduct an FBA.
I understand that a professional team will be assembled to conduct and review the FBA and develop an appropriate behavior intervention plan (BIP) for [child’s name]’s. I expect to be an active participant on the team for both the assessment of behavior and to develop the BIP.
I hope that this request can be expedited as [child’s name] has already been punished for behavior on [number of times] occasions this school year. [If your child has been suspended, note the number of times and dates.]
Please contact me at your earliest convenience so we can begin the functional behavior assessment process and address [child’s name] behavior more effectively.

The Tests

The functional behavior assessment does not include any testing, but often includes classroom observation by the behavior specialist who will be facilitating the assessment meetings and process.
The FBA team should include:
  • Behavior specialist (most school systems have these professionals on staff)
  • Parent(s)
  • Classroom teachers
  • Special education teachers
  • Other school personnel that work with your child frequently (guidance counselor, speech therapist, occupational therapist, school psychologist, etc.)
  • Principal and/or Vice-Principal
  • Your child (when appropriate)

The Time Required

It could take a few weeks to complete an FBA and draft and implement the Behavior Intervention Plan (BIP). Sometimes it’s difficult to align team members’ schedules.
The behavior specialist will first observe the student in the classroom. Then the FBA meeting can take place, which will last 1-4 hours, depending on the number of behaviors to analyze and each individual member’s ability to agree. From the outcome of the FBA, a BIP is drafted and distributed for implementation at school.
The FBA requires a fixed structure for the meeting — in essence determining the who, what, when, where, and why for each behavior. The meeting should:
  1. List and describe the inappropriate/unwanted behaviors, including what they look like specifically. Also note if there is aggression, violence, or destruction of property and if the behavior is a danger to self or others.
  2. Determine where each behavior is and isn’t happening.
  3. List the frequency of occurrence.
  4. Discuss who is involved when each behavior takes place.
  5. Discuss any potential environmental factors that lead to the behavior.
  6. Identify possible perceived functions for each behavior.
  7. Talk about the antecedents (what happens immediately before the behavior) and consequences (what happens immediately after the behavior).
  8. Define appropriate evidence-based strategies to effectively address the function of each behavior.

The Outcome

Once the FBA is completed, a Behavior Intervention Plan should be created. This document should identify each behavior listed in the FBA, and the associated strategies to be employed when these behaviors occur. Each intervention should focus on skill development when applicable, as that will be more successful in changing the behavior than simply behavior management.
Educators should track the goals and measurements for the BIP to monitor the effectiveness of the interventions and further identify which strategies are effective, and which strategies need to be modified. The FBA should be regularly updated and fluid.

Wednesday, May 8, 2019

Family Supports Waiver Public comment notice

On August 1, 2019, the Indiana Family and Social Service Administration Division of Disability and Rehabilitative Services intends to submit proposed amendments to the Family Support Waiver to the Centers for Medicare and Medicaid Services for consideration. The waiver amendment is available for review and public comment on the DDRS Draft Policies for Public Comment webpage.
This amendment adds a priority category for children of active or veteran members of the United States Armed Forces or National Guard, as required by House Enrolled Act 1296. Priority categories allow individuals who meet certain criteria to have immediate access to the Family Supports Waiver.
Comments for the amendment will be accepted until 4:30 p.m. EDT on Friday, June 7, 2019, and may be emailed to DDRSwaivernoticecomment@fssa.IN.gov or mailed to the address below. Hard copies of the proposed amendment changes are available by contacting your local Bureau of Developmental Disability Services office.
Waiver Amendment Public Comment
c/o Division of Disability and Rehabilitative Services
402 W. Washington St., #W453 P.O. Box 7083, MS26
Indianapolis, IN 46207-7083


There's one question we receive more often than others at CQL | The Council on Quality and Leadership, and it's a common issue that human service organizations face across the globe - how do you gather information about quality of life outcomes from people who do not use words to communicate? More specifically at CQL, we are asked how do you apply the Personal Outcome Measures® discovery process to people who communicate through non-verbal methods? 


By Gretchen Block CQL Manager of Partner Engagement
  1. Interviewers should always talk to more than one person who knows the individual well. Sometimes people suggest things that they think would or should be important to the individual vs. what the individual truly wants or needs.
  2. You shouldn't assume because something was important at one time in a person’s life, that it is important today. Our opinions and interests change over the years. Our past is part of our story, but it might not be the most important thing presently.
  3. Like Vickie referenced above, interviewers can be a detective of sorts, by observing body language, gestures, facial expressions, etc. You can ask to see the person’s personal space such as an apartment, bedroom, etc. It might be helpful for people to share their photo albums, class yearbook, scrapbooks, etc.
  4. In identifying the location for the interview, the interviewee might want to choose their favorite place to hang out. Can the POM interview happen there? It’s a great way to ensure you are in an environment that is comfortable for the person!
  5. A great activity for DSPs and people they support is to make a collage poster/book of all of the things that are important to the person before the POM interview and ask them to bring it to their interview. CQL has developed a free Person-Centered Plan Template that could be used for this purpose.
  6. One POM 'Golden Rule' is to always ask the question. You should never let a lack of words affect your ability to get the right answer.
  7. People receiving supports should be supported and encouraged to try new and different things. For example, vanilla ice cream might be someone's favorite but only because no one ever offered them mint chip. Everyone needs experiences, education, and exposure to the world around them in order to make informed decisions about what’s important, how to spend their time, who to spend their time with, etc. For people who do not use words to communicate, make sure to take note of their reactions to each of these new experiences.


By Vickie Overpeck | CQL Quality Enhancement Specialist
Observation is the first step. It’s important to observe people's body language including excitement, anxiety, frowning, smiling, withdrawing, shutting down, lighting up, and then reflect that "feeling" back to them:
  • Are you sad?
  • Are you excited?
  • Are you thinking about something fun?
Visual cues and tools can be used when talking about topics, such as sharing pictures of food while discussing dinner or having photos of places when deciding somewhere that people might like to go. Pictures should be simple and clear. Using professional advertising icons that are created by expert designers can be useful, as they are recognizable and help us associate imagery with places, things, or concepts. For example, most kids learn to recognize the McDonald's arches long before they can say "McDonalds" - same goes for other well-known icons that can be used in conversations about places to go or things to do.
Photos of others the person lives, works, or spends time with can be helpful in interactions and discussions by asking questions like "Who is this?" or "Do you know this person? Point to her/him and ask "Who is a friend of yours?" or "Who would you like to go to the movies with?"
Gestures and natural signs can accompany verbal communication, as they help people visualize what you are saying. Encourage them to use these signs too, like making a cup with your hand to talk about drinking something or putting both hands to one side of your head, tilting your head, and closing your eyes to talk about going to sleep.
Video recordings can by used by filming activities and then talking about it - if the person isn’t too shy or self-conscious for this approach. For others who are a bit of a "ham," even using a microphone might encourage them to speak more.
People looking at photo albumPicture albums will assist you in discussing interests, activities, and more, as they will encourage people to talk about the fun times they experienced. You can also use cookbooks with a lot of pictures to prompt people to talk about their favorite food, which is something that most everybody likes to talk about!
Preference testing can encourage communication. In this method you present two items in the same 'category'  - like two colors, two pictures, two shirts, two kinds of cereal - and ask, "Which one do you like better?" Then pay attention for a reaction such as a look, a head nod, a pointed finger, and acknowledge that choice, with responses such as "Did you pick the blue one?" or "I see you like Rice Krispies better than Corn Flakes - is that right?" After a while you can try three objects in the same category.
Expect the unexpected and get ready to be surprised when people communicate in new ways. Have high expectations for people and be prepared to be quiet, patient, and to listen with all your senses.
Have fun! Some people communicate best during engaging activities. I watched a group of adults who did not have effective communication skills play an exciting game of Yatzee - and, boy were they communicating during that game and everyone had a good time!
Woman completes The CQL POST AppObjects can be used to learn about topics. For example, when exploring grooming and personal care, you could fill a box with a hairbrush, toothbrush, small mirror, deodorant, wash cloth, bar of soap, comb - and so on. Then ask someone to take one item out of the box and show or "tell" how you would use the item. Encourage all efforts to communicate about the use of the item. One organization used this technique to teach people more about their rights.
Augmentative Alternate Communication (AAC) may be helpful. You can try different forms of AAC such as simple pictures, flash cards, or electronic devices with buttons that says things like "Yes" and "No" when pushed. iPads and other tablets have all sorts of apps available to help people express themselves. CQL has developed The CQL POST App, a user-friendly app that provides a snapshot view of a person’s quality of life, which can be completed either independently by the person receiving services or with support by others.

Friday, May 3, 2019

CMS Finalizes Rule to Protect Medicaid Provider Payments

Final rule ensures Medicaid providers receive complete payments as required by law
The Centers for Medicare & Medicaid Services (CMS) today released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope of what the statute allows.
CMS received more than 7,000 comments from the public, healthcare providers, unions, state agencies, and advocacy groups during the comment period for the proposed rule.  CMS took the comments into consideration when finalizing its proposal. 
“State Medicaid programs are responsible for ensuring that taxpayer dollars are dedicated to providing healthcare services for low-income, vulnerable Americans and are not diverted in ways that do not comply with federal law,” said CMS Administrator Seema Verma. “This final rule is intended to ensure that providers receive their complete payment, and that any circumstance where a state redirects part of a provider’s payment is clearly allowed under the law.”
Section 1902(a)(32) of the Social Security Act generally prohibits States from making payments for Medicaid services to anyone but the provider. The statute provides only a few specific exceptions to this requirement, such as allowing payment to be made in certain circumstances pursuant to an employment relationship, to medical facilities and billing agents, and under court-ordered wage garnishments.
In 2014, CMS revised the Medicaid Provider Reassignment Regulation to provide for a new exception to the direct payment requirement for certain providers, which primarily include independent in-home personal care workers. This new regulatory exception authorized a state to make Medicaid payments to third parties on behalf of certain providers . After further review, CMS has determined that the new exception created by the 2014 rule is not authorized by the statute and may have resulted in provider payments being diverted in ways that do not comport with the law. Therefore, CMS is finalizing the rule to remove this impermissible exception.

Five Things Parents and Guardians Can Learn on the Social Security Website

" "Our programs and services have evolved to accommodate the unique needs of families, especially the children in your care. Our website for Parents and Guardians includes information about the benefits available for children.
Here are five things you can learn more about on our Parents and Guardians page:
  1. Social Security’s promise — We know how much your loved ones mean to you. Our promise of a lifetime of protections extends to them. When you work and pay Social Security taxes, your children may also qualify to receive benefits on your record.
  2. It starts with your child’s Social Security Number —Our journey together begins at birth. A child needs a Social Security number if the child’s going to have a bank account or if you want to claim them on your tax returns. You can apply for your baby’s number and card right in the hospital when you complete the information for their birth certificate.
  3. What happens when disability strikes — Children with disabilities are among our most vulnerable citizens. Social Security is dedicated to helping those with qualifying disabilities and their families through our Social Security disability program and the Supplemental Security Income (SSI) program.
  4. When a parent or guardian dies— Our benefits help ease the financial burden on your loved ones after you die by providing monthly payments to eligible widows, widowers, children, and dependent parents.
  5. If you’re raising your grandchild — Your minor grandchildren may be eligible for benefits while you’re receiving Social Security retirement or disability benefits, in certain situations.
Visit our Parents and Guardians website for more information about these services. You can also get all the details about benefits for children by reading our publication, Benefits for Children.

Resolving Special Education Disagreements at the Local Level

From DREF (Disability Rights Education & Defense Fund):

This is Part 1 of a 2 part series on dispute resolution. This month we focus on resolving conflicts at the local level—before issues escalate to state complaints or due process hearings.
The purpose of the IEP team meeting is to create an IEP that will provide meaningful educational benefit in the least restrictive environment, based on evaluation data, input from all team members, including the parent and the student where appropriate, and after identifying what kind of specialized instruction, support, accommodations, modifications and services will ensure that these goals can be met. No matter what the reason, it can be very stressful as a parent to find yourself in disagreement with the school team. Parents are often unsure what appropriate next steps are in this situation.
An IEP can open the door of educational opportunity so that our children can learn and prepare for the life ahead of them. But sometimes the door is locked or blocked and we can't agree with the school district about how to open it. For example:
  • You requested evaluation for an IEP and the district refused, or they conducted an evaluation and found your child ineligible for services, or not eligible under the category you have reason to believe is the key concern. (For example, finding a student eligible under speech and language, but not autism when you have a medical diagnosis).
  • The district is proposing to exit your child from services you think are still needed (a 1:1 aide, or occupational therapy) or telling you that your child is no longer eligible for an IEP and you don't agree
  • You disagree with the type of support and how much support your child needs to meet IEP goals.
  • You disagree that an IEP goal is appropriate, or has or has not been met.
  • You disagree about what placement is being offered, how your child is being disciplined, or whether your child is being discriminated against because of a disability (for example, is not able to participate in field trips or other school activities) or is experiencing bullying.
How do you resolve the problem without hurting the relationships with staff who you may be working with for years to come?
Our first tip is "Don't Wait." Inaction can cause the conflict to simmer and escalate. Be proactive because time matters for children, and all of the processes described here take time. Parents are often worried that they will be seen as hostile or difficult if they raise their concerns, refuse to sign an agreement, or use their legal rights. But waiting too long to address concerns can make things worse and finding solutions more difficult.
Parents have access to a set of powerful protections called "procedural safeguards." In general, it is best to start at the local (school and district) level. Options can include:
  • Requesting a follow up IEP meeting (in writing--must be held within 30 calendar days except during vacations greater than 5 days). But be careful—if the team has met repeatedly on the same issue without resolution, it may be time to take the next steps.
  • Writing to higher–level administrators (a Special Education Director, for example), laying out your concerns and evidence to back them up.
  • Requesting an Independent Educational Evaluation (IEE) when you disagree with the assessments/evaluations the district/charter conducted (see our sample letters). New data and recommendations from a qualified assessor taking a fresh look or deeper dive who is independent of the school is often critical to developing an effective IEP.
  • Requesting a Facilitated IEP when meetings are becoming unproductive or hostile. A facilitator is an impartial, trained person who will work with a student's IEP team and will manage the meeting. The facilitator helps keep the IEP team members focused on developing the IEP while addressing conflicts and disagreements that may arise during the meeting, and tries to create an environment in which the IEP team members can listen to one another's points of view and work together to develop an IEP that is acceptable to both the parents and the school district. 
  • Meeting with the Special Education Administrator before filing a formal complaint or requesting a hearing, including requesting an Alternative Dispute Resolution meeting.
  • Requesting more assessment/evaluation by the district by someone with more expertise in the area of concern, so that both sides have data to consider, including in California, referrals to State Department of Education Diagnostic Centers.
  • Agreeing to try something different for a limited time period and then re-evaluating the situation. For example, delivering an evidence-based multi-sensory reading program to the student who isn't making progress for 60 days, to see if it produces results that will help the student reach a reading goal.
  • Filing a "local" or "uniform" complaint with the school district when you feel district policy, or state and federal law are being violated. Every principal should be able to provide these forms and a description of the process.
Local resolution works best when all parties recognize that while there is disagreement, flexible problem solving is in everyone's interest. It can be faster, save time and legal costs, and may preserve relationships with staff.
Next month, we will consider options when a local resolution process is either not effective or not appropriate.