What is the Difference Between a Medical Diagnosis of Autism and an Educational Diagnosis?

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Understanding the distinction between an educational diagnosis and a medical diagnosis is really important for families who have children with autism. A medical diagnosis will allow a child to gain access to medical services such as ABA and will be paid for by Centennial Care or private insurance in the state of NM.  In contrast, an educational diagnosis of autism will allow a child with a child to access special education services in his/her school setting.

There are two criteria that have to be met for a child with autism to receive an educational diagnosis of autism and receive special education services.

  1. He/she has to have a diagnosis of autism to qualify for the exceptionality of autism under IDEA.
  2. The IEP team has to agree that the child needs specialized instruction (special education services) to access her/his educational environment.

Often, how an educational diagnosis is determined in NM's schools is incorrect and is being used to deny children with autism special education services.  In addition, parents are often confused when their children have a medical diagnosis of autism but then are told (by their schools) that their children do not have an educational diagnosis of autism and the difference between the two isn't explained.

The question parents often ask me is, "How can my child have autism everywhere else, but not in school?" This a really good question and the answer is, children do not have autism everywhere else, but not in school. It is just that to receive an educational diagnosis, the child has to have challenges in school that qualify her/him for special education services. A helpful visual can be found at https://www.webpsychology.com/difference-between-education-identification-and-medication-diagnosis-autism-spectrum-disorder. However, it should be noted, there are two places in the link provided that do not apply to NM.

  1.  New Mexico Centennial Care and private insurance must cover evaluations for a medical diagnosis of autism
  2.  IDEA mandates that private evaluations be accepted and considered in the IEP process.

A school evaluation for autism does not trump a medical diagnosis. Both evaluations must be considered by the IEP team (which must include the parents) to determine if the child falls under the exceptionality of autism according to IDEA. If the answer is yes, the child has the exceptionality of autism, then the team must decide if the autism exceptionality is affecting the child's ability to fully access her/his educational environment to the extent that specialized instruction is needed. If the answer is yes, the child required specialized instruction, then the child qualifies for special education services and, therefore, meets the school's definition of an educational diagnosis of autism. 

 

Special Education Services must Produce a Prepared Adult

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Special education services are legally required "to ensure that [a child] with [autism has] available to [him or her] a free and appropriate public education (FAPE) that emphasizes special education and related services designed to meet [her or his] unique needs and prepares [him or her] for further education, employment and independent living" and the public school system is required by law to provide such services. This is required by Federal special education law as defined in the Individuals with Disabilities Education Act (IDEA) of 2004, 20 U. S. C. Section 1400 (d). * To accomplish these goals, special education and related services must be defined in a child's Individualized Family Service Plan (IFSP), if he or she is 0-3 years old; or in an Individualized Educational Plan (IEP) if she or he is 3 - 22 years old. If a child with autism is not prepared for "further education, employment and independent living" when he or she leaves high school, then that child's public school system has failed to meet the legal requirements of a special education as outlined in IDEA and it may face legal consequences. If you question whether or not your child is receiving the special education services needed for life after high school please contact me  for consultation or for legal questions contact a special education lawyer in your area.

*Peter Wright, Pamela Wright, Wrightslaw: Special Education Law, 2006, page 48

NOTE: Bright Futures: Autism and Early Intervention has no official or unofficial relationship with Wrightslaw. 

#BrightFuturesASD

 

Self Funded Insurance Plans and Applied Behavioral Analysis

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There have been some very exciting developments in the area of autism specific service, especially Applied Behavioral Analysis (ABA). In New Mexico, any person under the age of 21 with a medical diagnosis of autism may receive ABA through their private insurance or Medicaid. However, if your child is covered under insurance that is self funded (a policy that is funded by your place of employment), ABA may not be covered. If your child needs ABA services and it is not covered through you company's self-funded plans, you might look into purchasing an individual plan for your child on your New Mexico's Health Exchange which is covered by the Affordable Care Act/Obama Care. All plans on the New Mexico's Health Exchange must cover all autism specific services including ABA if they are medically necessary. 

Here's to Bright Futures for all children!

#BrightFuturesASD

 

 

 

Affordable Care Act (ACA) and Applied Behavioral Analysis (ABA)

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In New Mexico; Medicaid and  commercial insurance plans are required, by law, to cover Applied Behavioral Analysis (ABA) for child up to 21 years old who have autism. Often, families are able to get ABA for their children with autism by purchasing an individual policy through their state's Affordable Care Act (ACA) because the ACA mandates that Applied Behavioral Analysis (ABA) be covered as well. If you want more general information about enrolling in the ACA (otherwise known as Obama Care) go to HealthCare.gov. If you want to go to the NM ACA website to enroll click here Be Well NM. (Click on any of the words in BOLD and you will be directly linked the website)

Here's to Bright Futures for all children! #BrightFuturesASD

 

Copy of To ABA or Not to ABA - In Support of Intensive Early Intervention

I would like to take a minute to discuss the concern that intensive intervention aims to change a child who has autism into some idea of normal. I would offer that normal (whatever that is) should not be the goal of any therapy, intensive or not. The overall goal is to help a child and his or her family realize their unique potential, their unique dreams, and have autism or any other challenge be a gift not a burden. A family may choose not to have research based; intensive, early intervention (usually based on Applied Behavioral Analysis) for their child but every child who has autism should have this option. This option should be a medical and educational given because when it is done well it the most direct path to long term, positive outcomes.

It is so important for families to know about Applied Behavioral Analysis (ABA). To understand that, for most children on the autism spectrum, it is the path to a bright future. Parents need to know what ABA can do for their children when it is done well and they need to know how to access it. In many states commercial insurance must pay for it. In all states ABA must be made available to those covered by Medicaid or accessing insurance through ACA (Obamacare). I am not saying ABA is the way to go for every child or every family but in every case it should be an option. To minimize or discount ABA for children on the autism spectrum is doing a disservice and in some cases out and out harm by closing the door on possibly the one therapy that could change the trajectory of a young child's life.

For more information about ABA and access to autism specific therapies in your state contact Zoe@BrightFuturesASD.com or call 505-471-4505.

Here is to Bright Futures for all children!

 #BrightFuturesASD

OPEN ENROLLMENT for ACA and Self-Funded Insurance

Self-funded insurance can be an obstacle to accessing applied behavioral analysis (ABA) for many children with autism because ABA is not covered under many self-funded plans. If families want companies to put ABA coverage in the self-funded health insurance policies offered, they can contact Autism Speaks' Lorri Unumb at Lorri.Unumb@AutismSpeaks.com. Autism Speaks will often provide advocacy support by speaking to a companies HR department. Hear more about this in the Autism Speaks Town Hall Meeting by clicking this Town Hall Link and going to 28:18 on the time line. 

Here's to Bright Futures for all children!

#BrightFuturesASD

 

Get Autism Services Covered by Insurance: Open Enrollment for Affordable Care Act Starts November 2, 2017

Lack of insurance reform and self-funded insurance is still an obstacle for many families in accessing autism specific services. The “work around” for many families is to buy an individual plan for their child through their states federal insurance exchange (Affordable Care Act/Obamacare). Most plans offered through the Affordable Care Act must pay for ABA or any other medically necessary service for a person with autism. If you would like more information contact me at Zoe@BrightFuturesAEI.com or call 505-471-4505.

Here's to Bright Futures for all children!

#BrightFuturesASD

 

Autism: Honoring the Voices of Everyone

It is important to honor the voice of everyone who has been touched by autism. Whether you want to call yourself or someone autistic or use the language of having autism. It is the spirit of inclusion and sensitivity that is important. The goal for me in my practice, supporting children with autism and their families, is to help families find out what supports are going to help, what supports are right for them and to ensure that the those supports are available and accessible.

Here is to Bright Futures for all children!

#BrightFuturesASD

 

 

Insufficient Services: Concerns for Children with Autism

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Many children with autism are not getting the early intervention required to ensure they are able to function in their homes, communities and succeed in school. This is often a recipe for failure.

Most children with autism have average intelligence, just like any other child their age. Children with autism can; however, have challenges with communicating, especially if they have not received early intervention. Early intervention when done well can assist most children in gaining a functional system of communication.

Good early intervention is now available in most states in the US and is available in New Mexico. If pediatricians do the M-CHAT-R autism screening at 18 months children who flag for concerns for autism will be referred for evaluation and given a diagnosis of autism if appropriate. Once they receive the diagnosis they will qualify for intensive intervention through insurance (commercial and Medicaid). This intensive intervention most often comes in the form of Applied Behavioral Analysis (ABA) and it is typically provided one to one, in the home, for up to 40 hours a week. ABA is one intervention that can fulfill the promise of a bright future for almost every child on the autism spectrum. It often recommended and is medically necessary for children with autism because it has been proven to provide the most positive outcomes possible.

There are now a number of good ABA providers in New Mexico and many ABA providers throughout the US that provide intensive services to children and youths who have a diagnosis of autism. These ABA providers are a huge part of the solution and should be an accessible option for any child for whom it is deemed medically necessary or for any child who needs it to access their educational environment. 

If you want more information contact Zoe Migel, LCSW, at Zoe@BrightFuturesAEI.com or 505-471-4505.

 Here is to Bright Futures of all children!

#BrightFuturesASD

 

To ABA or Not to ABA - In Support of Intensive Early Intervention

I would like to take a minute to discuss the concern that intensive intervention aims to change a child who has autism into some idea of normal. I would offer that normal (whatever that is) should not be the goal of any therapy, intensive or not. The overall goal is to help a child and his or her family realize their unique potential, their unique dreams, and have autism or any other challenge be a gift not a burden. A family may choose not to have research based; intensive, early intervention (usually based on Applied Behavioral Analysis) for their child but every child who has autism should have this option. This option should be a medical and educational given because when it is done well it the most direct path to long term, positive outcomes.

It is so important for families to know about Applied Behavioral Analysis (ABA). To understand that, for most children on the autism spectrum, it is the path to a bright future. Parents need to know what ABA can do for their children when it is done well and they need to know how to access it. In many states commercial insurance must pay for it. In all states ABA must be made available to those covered by Medicaid or accessing insurance through ACA (Obamacare). I am not saying ABA is the way to go for every child or every family but in every case it should be an option.

I would argue that to minimize or discount ABA for children on the autism spectrum is doing a disservice and in some cases out and out harm by closing the door on possibly the one therapy that could change the trajectory of a young child's life.

For more information about ABA and access to autism specific therapies in your state contact Zoe@BrightFuturesAEI.com or go to www.BrightFuturesAEI.com.

Here is to Bright Futures for all children!

 #BrightFuturesASD

 

Early Intervention for Children with Autism: Get On With It!

 

Hopefully, everyone knows early intervention is critical to long term, positive outcomes for children with autism. However, sometimes the journey to receiving early intervention is overwhelming and a guide is needed. Here are some stepping stones to help along the way. 

1. Identify - Most children with autism can be identified as early as 18 months.  Children's doctors need to complete the Modified Checklist for Autism in Toddlers - Revised (M-CHAT-R) at every child's 18 month and 24 month well check.

2. Diagnosis - Most Children with autism can receive a reliable diagnosis prior to the age of three. Timely evaluations must be available to those who children who screen positive for risk of autism on the M-CHAT-R.

3. Medical and Educational Services - Free Applied Behavioral Analysis (ABA) available to every child in his or her home and community immediately after an autism diagnosis is received.

In summary: Identification of concerns, a diagnosis of autism before the age of 2 and immediate implementation of intensive ABA services.

For more information contact Zoe@BrightFuturesAEI.com or call 505-471-4505.

 #BrightFuturesASD

 

Autism: A Different Point of View

How do you find joy and happiness when you feel the walls are closing in and you cannot conceive of an exit?

I often read that self-care is the key to more joy and happiness. To that many parents of children with autism would say, "Self-care... Are you kidding me! I cannot remember the last time I slept through the night. I don't know when I showered last. A bath? Your are kidding, right?"

Here are some of the common recommendations from the internet on how to take better care of yourself. I am sure it is nothing parents with a child on the autism spectrum haven't heard already.

1. Be willing to accept help

2. Keep a list of what others can do to help

3. Use time to recuperate, not to get more work done

4. Utilize every possible (safe) respite opportunity

5. Get involved in a community

6. Encourage independent playtime

7.  Individual or Group Therapy

I know these are reasonable recommendations but many of the parents I work with in my private practice would say, “Blah, blah, blah! Really? Really! If I cannot find time for a shower, how do you expect me to find time to make a list? Find a babysitter. Get involved in the community. Teach my kid to play by himself (my child’s therapist told me to not let him do that). AND go to individual AND group therapy?”

I hear you! Sometimes finding time is just another chore, another thing to do and more trouble than it is worth. Life can be really hard. Work can be really hard. Parenting can be really, really hard. Parenting a child with the challenges of autism is really, really, REALLY HARD! There needs to be something more than just another to do list. There needs to be something that is quick and easy and gets to happiness and joy fast. What's the key?

It turns out the key to finding joy and happiness is in the passing moments of your life and how you chose to experience them. You do not have to DO anything different. You just have to shift your thinking a bit.

It is about how we choose to think about things. Do we see a dark cloud or do we see the silver lining? If you slam the door and spiral into the hole of misfortune and despair, you have but one dark road. Getting an autism diagnosis is often a crushing experience that can dim all dreams for your child’s future and it does take time to process.

As you process, though, I gently encourage you to think about autism in a different way. To experience more joy and happiness; try to think about autism in a different, positive way. I encourage you to remember all the good times and all the tender times with your child. Focus on what he can do. See your child’s strengths! I encourage you to remember that the diagnosis did not change your child but does provide information about what your child may need to reach his potential in life.

It is a philosophical shift in how you view autism. Like so many things in life; once you are open to the potential, you are able to see the future as many roads headed towards opportunity. Joy and happiness can walk right through your door helping you move towards a beautiful and bright future.

The following three TED Talks are about happiness and joy. You might be surprised by who is happier than who and why.

Hope they help bring more joy and happiness to your life. Here is to Bright Futures for all children!

 

For more information on autism contact Zoe@BrightFuturesAEI.com

 

Zoe

#Autism #BrightFutures


 

 

 

Supporting Autism Services in Santa Fe!

 

A Call To Action!

How do we in Santa Fe; a progressive, affluent community, support families who have children with autism? We can do this by increasing the understanding of what children on the spectrum need to succeed and by ensuring that private insurers and Medicaid create an adequate network of providers that specialize in treating autism.

The CDC states that 1:68 children in the US have autism. Based on these ratios and the 2013 New Mexico census, there are 431 children under the age of 18 who have autism in Santa Fe and 108 of those children are under the age of five. In Santa Fe, these children often wait over a year and a half for an autism diagnosis without which they cannot access appropriate services. Once they receive a diagnosis, they often have to wait another nine months to a year for intensive autism supports. This means a three-year-old child, for whom there is concern about autism, will be five by the time he gets the services he needs.

Intensive services for children with autism include applied behavioral analysis (ABA). The intensity of ABA services is often 20-30 hours a week and is provided in the home and community.  Research shows, time and time again, that ABA services are critical in helping children and youths grow into functional, independent adults. This is why, in New Mexico, private insurance, such as Presbyterian or Blue Cross Blue Shield, and Medicaid are legally mandated to provide medically necessary ABA for children and youth up to the age of 21 who have autism.

However, most families in Santa Fe who have a child with autism remain uninformed of these services and never pursue access to ABA. That said, even when a family requests ABA, the best-case scenario for a child with autism in Santa Fe is referral to a local ABA provider. Unfortunately, none of the current providers in Santa Fe are providing ABA for new clients. However, the child (new client) will be put on the ABA provider’s waitlist. That child may get lucky and get services in the next few months but it is more likely he will wait upwards of a year.

This lack of information regarding appropriate treatment for autism and a shortage of ABA providers in Santa Fe is affectively denying children with autism timely access to desperately needed, medically necessary care; profoundly affecting the children and families of our community.

This is a call to action! Please contact Zoe@BrightFuturesAEI.com or call 505-471-4505 if you are a parent of a child with autism and would like more information regarding access to applied behavioral analysis (ABA) services in Santa Fe. www.BrightFuturesAEI.com

#Autism #BrightFutures

Child with Autism Attend Mainstream Kindergarten!


Please, if you or your pediatrician are concerned about autism get an evaluation so you and your child can get support! 

According to the CDC, the average age of diagnosis is 4-5 years, but a reliable autism diagnosis can be made as early as 18-24 months. While early detection is critical, research shows that many parents have very little knowledge about autism and its symptoms. The current age of diagnosis among low income families, as well as African Americans and Hispanics, is higher than the general public. With appropriate early intervention services from ages 3-5, between 20 percent and 50 percent of children diagnosed with autism will be able to attend mainstream kindergarten.

If you would like more information regarding available supports, email Zoe Migel at Zoe@BrightFuturesAEI.com or call 505-471-4505.

Here is to Bright Futures for all children!

#Autism #BrightFutures 

Anatomy of an IEP by www.understood.com

This web article (click here) https://www.understood.org/en/school-learning/special-services/ieps/at-a-glance-anatomy-of-an-iep?  provides a good explanation of the building blocks of an Individualized Educations Program (IEP), which is the special educational plan - children with autism 3-21 years old. This general format also will apply in some ways to an Individual Family Service Plan (IFSP), which is the plan for early intervention services - children with autism 0-3 years old. If you have more questions about these plans or services in general please contact zoe@BrightFuturesAEI.com.

Here is to Bright Futures for all children! 

#Autism #BrightFutures #ABA #Advocacy #IEP


Support Your Child's Future: Get Insurance to Pay for Autism Specific Services (A.K.A ABA)

If you have Medicaid or private insurance your child is most likely entitled to receive 15 - 40 hours of Applied Behavioral Analysis (ABA) a week as well as other autism specific services. These services are provided for your child in your home and community and support your child's development in areas such as talking and potty training to name two that are high priority for families. You have paid your premiums and Medicaid has been ordered by the federal government to provide ABA services.  It does not matter is there are no providers in your area. This is not your problem to solve. It is the insurance companies responsibility to provide these services and, if they can't, you have the right to hire your own provider at the insurance companies expense. Therapeutic support is often critical to your child's future success so don’t wait. Get the services your child deserves now! See the video below for more info.

 

#BrightFutureASD



If you have questions or need support to access ABA or other autism specific services in your area please contact Zoe@BrightFuturesAEI.com.

Here is to Bright Futures for All Children!

#BrightFuturesASD

 

Adequate Network of Care - Autism Training June 2015

Here is information on the Adequate Network of Care mandate for insurance companies. Commercial and Medicaid insurers must provide and adequate network of care that includes ABA and other autism specific services as well as evaluations. An adequate network means services must be provided by: qualified providers, in a reasonable time and distance in the child's primary language. If the insurer cannot provide an adequate network of providers they must pay for an out-of-network provider so that medically necessary services are available to those covered by the health plan. If you have any questions contact Zoe@BrightFuturesAEI.com or call 505-471-4505.

Here is to Bright Futures for all children!

#BrightFuturesASD

 

#Autism #BrightFutures #ABA #Advocacy #Training


Accessing Autism Services (Applied Behavioral Analysis) in the United States

Years have passed since the federal Centers for Medicaid and Medicare announced that states must offer Behavioral Health Treatment (Applied Behavioral Analysis or ABA) for children with autism under 21-years-old on Medicaid.

In many states Autism services are currently available on paper but there is an inadequate network of care (very few providers) and as a result very long wait lists (sometimes years) and in many rural areas there is no access to ABA at all. Families need to know their rights especially around insurance companies' legal responsibility to provide an "adequate network of care". An adequate network of care includes timely access to services (including evaluations) within a reasonable distance provided by qualified personnel in the patients/clients primary language.

Please contact me at Zoe@BrightFuturesAEI.com or 505-471-4505 if you have any questions about autism specific services and/or how to access them. 

Here is to Bright Futures for All Children!

Best, Zoe

 #Autism #BrightFutures #ABA #Advocacy

 

 #Autism #BrightFutures #ABA #Advocacy

Weekly Update: Word of Mouth - Resources Network for Autism

Word of mouth...Wrights Law has a great website and it updating its resource network. If you need services or know someone who is a fabulous provider take a look at this link to the website. http://www.yellowpagesforkids.com/.

In my practice supporting children with autism and their families I find that the two biggest challenges to getting the supports needed is knowledge of available services and knowing how to access them. The Wright Law website helps overcome both these challenges.

Here is to Bright Futures for all children!

Zoe Migel, MS, LISW, LSSW

#BrightFuturesASD

 

 

 

Zoe Migel, MS, LISW, LSSW