What are the services? • Consultation for Assessment/Individual Program

Design/Training- (23 hours) • Ongoing Consultation-program implementation & monitoring

(5.5 hours/month) • Therapeutic aides and behavioral reinforcers (1 time flat rate) • Lead therapy (6 hrs/wk) • Line therapy (30 hrs/wk)

– Parent involvement (minimum of 14 hours/wk) • Independent Treatment Evaluation/Quality Assurance (36

hrs/first yr; then 24 hours year 2-3)

What are the service rates? Service Rates Paid Staff Total Billed (includes

20% admin fee for providers)

Consultation for Assessment/ Individual Program Design/Training

$87/hour $104.40/hour

Ongoing Consultation $87/hour $104.40/hour

Therapeutic aides & materials

$1000 one-time max. $1000 one-time max.

Lead therapy $25/hour $30/hour

Line therapy $15/hour $18/hour

Independent Treatment Technical Assistance

$87/hour

$104.40/hour

Consultants

• SLPs 14 • BCBAs 13 (4 doctoral level) • BCBA/SLP 3 • SPED 8 • PSYCH 6 • OT 1

BACB: 30 BCBAs and 2 BCaBAs in AR currently

Active Providers • Arkansas Support Network (ASN)-16 • Sunshine School & Development Center - 5 • Bost- 6 • First Step - 6 • Focus - 10 • Helping Hand Learning Center -17 • Howard County Children’s Center - 2 • Independent Case Management (ICM) – 40 STATEWIDE • Gregory Kistler Treatment Center - 4 • Lonoke Exceptional School- 3 • Magnolia Specialized Services - 4 • Pattillo Center School - 1 • United Cerebral Palsy (UCP) – 16 STATEWIDE

Inactive Providers • Advantages of Southeast Arkansas • AEDD • Carroll County Learning Center * • Friendship Community Care * # • Independent Living * # • Jenkins Memorial Center • Pathfinder • Rainbow of Challenges • South Arkansas Development Center for Children and Families • Steudlein Learning Center * • Stepping Stone School for Exceptional Children • Support Solutions • The Allen School * previously served child but none active # no longer participating

Provider Changes

• Parents have the right to choose providers initially and to change at any time

• 21 have exercised the right to change

Applications Received as of 083114 Total = 188

59

9 11

9 6 5 5

3 5

8 5

3 3 5

3 4 7

4 8

5 5 8 8

0

10

20

30

40

50

60

70

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

Applicants by Month 10/1/12 to 08/31/14

Applicants

Summary of Total Applicants

• 10/1/12- 8/31/14 188 applications • 42 counties in Arkansas and 1 county in

Missouri • Highest number of applicants were in

Pulaski (38), Benton (18), Washington (15), Craighead (13), Sebastian (11)

18 1 2 2

4 15 1 1

1

1

1

4 3

9

6 1

4 2 3

1

5

3 11

1

38

3

1 1

3

3

4 1

2

1

2

1

1

2

5

1

5

13

Applicants by Gender 08/31/14

26

162

0

20

40

60

80

100

120

140

160

180

Female Male

Applicants by Gender

Female Male

Total Applicants by Ethnicity 08/31/14

4

28

7

134

4 11

0

20

40

60

80

100

120

140

160

Asian Black or African American

Hispanic or Latino White Other Not Specified

Axis

Titl

e

Applicants by Ethnicity

Total Applicants by Age at Application 08/31/2014

0 2

28

65

89

4 0

10

20

30

40

50

60

70

80

90

100

<1 year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years > 5 years

Applicants by Age at Application

Status of Applicants as of 08/31/14

96

4

30 22 20 16

0

20

40

60

80

100

120

Status

Active Pending Discharged Criteria Not Met Waiting List Incomplete Application

Criteria Not Met

• Age (10) – 4 aged out while on the waiting list – 2 aged out with application still incomplete – 4 were > 5 years of age at the time of application

• Diagnosis (4) • LOC (2) • Moved (1) • Parent Withdrew Application prior to approval

(5)

Discharge Reasons • Compliance Issues with minimum required hours (7) • Moved out of service area (3) • No longer met LOC criteria after 1 year of AAP services

(3) • Parents withdrew (17)

– Parents who changed their mind before receiving services – Parents who wanted less than 20 hours per week of Line

Therapy – Parents who withdrew for personal reasons including new

job, change in work hours, pregnancy, personal illness, family issues

– Parents who chose to pursue other treatment options

Outcomes

• All children have progressed as measured by the ABLLS-R (Assessment of Basic Language and Learning Skills)

• Highest # of skills acquired: 983 (12 months) • Lowest: 9 (just started)

ABLLS-R • Basic Learner Skills

• Cooperation/Reinforcer Effectiveness • Visual Performance • Receptive Language • Imitation • Vocal Imitation • Requests • Labeling • Intraverbals • Spontaneous Vocalizations • Syntax and Grammar • Play and Leisure • Social Interaction

• Academic Skills • Self-Help Skills • Motor Skills

ABLLS Outcomes

9

7

20

17

8

14

5 4 4

2 2

0

5

10

15

20

25

Number of Children

Axis

Titl

e

New ABLLS Skills Acquired

9 to 50

51 to 100

101 to 200

201 to 300

301 to 400

401 to 500

501 to 600

601 to 700

701 to 800

801 to 900

901 to 1000

Child #1 • Came into the program just after he turned 3 • Lives in NW ARkansas • Dad is stay at home Dad so he could get maximum services • Started: Non-verbal, limited eye contact, only drank liquids from a Sippy

cup, not potty trained • Been in the program for 22 months • Now: 749 new skills acquired on the ABLLS • He is very verbal, makes great social eye contact, initiates interaction, is

eating 3 meals a day, almost completely potty trained, about to start in a preschool setting to give more social opportunities before kindergarten

• Cost: Averaged $1920/month; $23,045/year

Child #2 • Came into the program just before he turned 5 • Lives in Marianna • Started: Not very verbal; hard to understand what he did say; some eye contact;

difficulty staying on task; couldn’t write without hand-over-hand prompting • Will receive a total of 1 year and 10 months of services, turns 7 in December • Now: 657 new skills acquired on the ABLLS • He started kindergarten last year 4 days a week for half days. He had parts to recite in

the kindergarten graduation ceremony and recited them “perfectly”. “He sat beside his peers the entire time and acted like any other kindergartener. He would get antsy at times, he would lean over and talk to his peer sitting beside him, or he would get excited when it was time to sing the song he liked best”

• He is attending regular kindergarten and doing “wonderfully” with no pull-out special ed, except 30 minutes/wk of SLP. On the 3rd Monday after school started, he wrote his full name with no prompts. Took a common core math test this week totally independently, no prompts, no reminders to focus, wrote everything himself, made 100%

• Cost: Averaged $560/month; $6,719.45/year

Parental Satisfaction

• Surveys provided at yearly home visit for reassessment

• Of 76 provided, 31 were returned- 41% response rate

• 1 to 5 scale with 5 being the best and 1 being the worst

• Questions addressed 3 categories: – Program – Provider agency – Partners

Parent Satisfaction Survey

Frequency of Responses to Survey Items Strongly Agree

Agree Neutral

Disagree Strongly Disagree

The program has contributed to my child’s progress. 20 8 2 0 1 The program has contributed to reducing stress for my family.

16 8 5 1 1

I would recommend the program to other parents of children with autism.

25 4 1 1 0

The agency (provider) started services in a timely manner.

13 10 3 3 2

The agency (provider) communicates appropriately in a clear and concise manner.

12 10 6 2 1

The agency (provider) provides quality services appropriate to the needs of my child.

18 7 4 1 1

The agency (provider) has been responsive to issues / concerns I have raised.

17 10 3 0 1

Partners’ staff explained the program to me in a clear, understandable way.

22 7 2 0 0

Partners’ staff interacted with me in an appropriate, professional manner.

27 4 0 0 0

Partners’ staff has responded to issues that I have raised to their attention.

19 9 1 0 1

Parent Satisfaction Survey

4.5 4.2

4.7

3.9 4.0 4.3 4.4

4.6 4.9

4.3

0

1

2

3

4

5

6

Parent Satisfaction Survey Results

Overall Cost

• Highest monthly cost $2,128 ($25,536/yr)

• Average monthly cost $809 ($9,708/yr)

• Total Expenditure: $1,394,023.15 11/9/2012 to 10/8/2014 (23 mo)

Stumbling Blocks

• New program “bugs” • Misinformation • Billing glitches

• Available workforce • Rural areas VERY difficult to staff • Fidelity in implementation of evidence-based

interventions

• Early identification/diagnosis • Program differences: home-based; parental

participation

Future

• Pilot expires 10/1/2015 • Working on desired changes for resubmission

to CMS • Need to expand # of slots to respond to

waiting list to improve likelihood of approval

• Older children need something too!