10 Easy Steps of Audit and Survey Readiness

Annual audits and surveys can be very intimidating. A group of state surveyors showing up at the residence or day program to review services given to individuals with developmental disabilities.

What is the purpose of the audit?

In each state, Immediate Care Facilities (ICF), Immediate Residential Alternatives (IRAs), Waiver services or privately operated programs are funded through Medicaid Assistance Annually State agencies. Annual surveys serve the purpose of recertifying facilities and to make any further recommendations. Overall, the goal is to ensure the quality of for the individuals receiving services.

What are surveyors looking for?

In recent years, the focus is more on ensuring facilities that provide services and supports to individuals with intellectual and developmental disabilities are providing opportunities for individual choices including person-centered planning, community inclusion and choice-making. Typically, State auditors will review the Individualized service Plan (ISP) document to determine it the ISP is both current and accurate.

Audit Preparation

State Auditors generally spend some time talking to staff. They may ask you questions relating to the person’s plan. The questions are often generated after they have read the individual’s ISP plan. The questions that are asked are more than likely things that you do well everyday. here are 10 easy steps as you prepare for the auditing process:

  1. Knowledge of Individuals. know each person’s plan including person-centered planning plan, medical needs, preferences and habilitation plan.
  2. Cleanliness. Make sure the environment is neat and orderly.
  3. Privacy. Remember to give the person privacy when needed.
  4. Choice. Offer choices throughout activities whenever possible. The auditors may ask you how do you teach choice-making.
  5. Tone. Always speak in a positive and appropriate tone of voice.
  6. Small groups. Work in small groups whenever possible. Incorporate variety  of choice during activities.
  7. Community activities. Ensure individuals are able to make choices in activities in the community and community inclusion opportunities are available.
  8. Universal Precaution Guidelines. Know the precautions and follow them. Remember to change gloves when moving from one individual to the next.
  9. Active Programming. The auditors may ask questions related to what they have read in the individuals ISP or CFA (Comprehensive Functional Assessment).
  10. Safeguards. make sure you are able to describe the individual’s supervision needs.

Remember: Demonstrate your self-confidence, because you are good at what you do!

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Election Lesson Plan and Activities for Day Hab

Since President Trump’s, election, there has been a vigorous interest in politics not only in the United States but also in other countries as well. The upcoming mid-term elections provides an opportunity for adults with developmental disabilities to participate through a lesson plan created not only on the upcoming election, but also ways to get individuals more involved on topics and platforms that impact their lives.

Sadly, I have heard very little from politicians on issues concerning people with disabilities and the impact it will have on people with disabilities and their families. This affords an opportunity to have real discussion with people on issues that are important to them through a series of multisensory activities.

  1. Who doesn’t like a game of bingo? Download the bingo template, make as many copies as you wish and set up an activity playing Bingo. Once you call out a name. use it as an opportunity to have discussion i.e. How would you describe a conservative? When is the election held? Below, click on the template


Bingo.download

2. The second activity includes a week-long lesson plan on election and representative in office using a multisensory approach.  The first day is set up for making an apple smoothie and a trip preparation activities allowing individuals to work on their social and money management skills. I left the lesson plan editable so that you can move activities around as you wish.


election.dayhab

Materials Needed for the lesson plan activities

Mock Voter Registration

mock voter registration

Apple Smoothie Recipe

Apple Smoothie Recipe

Caramel Apple Smoothie

Patriotic Printable Paper Chain

Free patriotic printable chain

Patriotic paper chain with needed supplies

Oh, this is also a great activity to use a home or school for students at the high school level.

 

15 Halloween Fine Motor Skill Activities

Candy is not the only great thing about Halloween. It is a chance to work on fine motor skills and eye-hand coordination while having fun at the same time. From ghosts to witches, there are a number of activities you child or student can do that will help increase fine motor skills. For some children and adults with disabilities, struggle with fine motor skills. These activities are a chance to improve the coordination between the brain and the muscles including dexterity and motor control. Click on the links below.

Easy Halloween fine motor activity

Eyeball sensory bag

Feed the spider

Frankenstein monster pumpkin

Halloween fine motor: Giant lacing spiderweb

Halloween fine motor activities for preschool

Halloween fine motor activities that promote cutting practice

Halloween mask to print and color

Halloween Necklaces

Halloween Play Dough

Halloween themed cutting tray

Scissor skill pumpkins

Spider web yarn

Witchy fingers

Yarn wrapped spider craft for halloween

15 Visual Schedule Resources

Imagine during the course of the day you have no idea what is expected of you. Moving from one activity to the next depending on others to inform you of your daily plans. there are many benefits to using visual schedules especially for autistic children and adults. Studies show that many people diagnosed with autism experience high levels of anxiety often caused by unstructured activities.

Visual schedules are a way to communicate an activity through the use of images, symbols, photos, words, numbers and drawings that will help a child or adult follow rules and guidelines and understand what is expected during the course of the day.

Th following are resources containing information on creating visual schedules and free printables:

8 types of visual student schedules

Building a daily schedule

Daily visual schedule for kids free printable

Examples of classroom and individual schedule and activity cards

Free picture schedule

Free visual schedule printables to help kids with daily routines

Free visual school schedules

How to templates- visual schedules

How to use visuals purposefully and effectively

Time to eat visual schedules

Using visual schedules: A guide for parents

Visual schedule for toddlers

Visual schedule resources

Visual supports and autism spectrum disorders

What is visual scheduling?

What is Prader Willi Syndrome?

May is Prader Willi Syndrome Awareness Month

What Exactly is Prader Willi Syndrome?

Prader Will Syndrome is a genetic disorder resulting from an abnormality of chromosome 15 such as a loss of active genes. In most cases (70%) the paternal copy is missing and in some cases (25%), will exhibit two maternal copies of Chromosome 15. The genetic disorder was initially described by John Langdon Down and was named after Drs. Andrea Prader, Heimrich Willi and Alexis Labhart in 1956 and is found in 1 in 20,000 births affecting both sexes. It is also the most common recognized genetic form of obesity.

During childhood, individuals diagnosed with Prader-Willi Syndrome tend to eat constantly leading to obesity and for some, type 2 diabetes will develop. This complex disorder affects appetite,growth, metabolism, cognitive functioning and behavior.

Signs and Symptoms

People with Prader-Willi Syndrome (PWS) tend to never feel full (hyperphagia) which leads to constant eating. Signs in infants include, problems with strength, coordination and balance. Often there are feeding problems at birth, delayed speech and gross motor development. Children may be born with almond-shaped eyes and undeveloped sexual organs. Cognitive disabilities and developmental delays may also be present.

As children began to grow, constant craving for food often leads to behavior challenges including hoarding food, eating frozen food and food left in the garbage causing controlling or manipulative behavior.

Medical Issues

Medical concerns may include the following:

  • Sleep Apnea
  • Respiratory/Breathing
  • High pain tolerance
  • Severe stomach illness
  • Difficulty with vomiting reflex
  • Excessive appetite
  • Binge eating
  • Eye problems
  • Choking
  • Hypothermia
  • Leg Swelling
  • Consuming unsafe items
  • Negative reactions to medications
Teaching Strategies

Most people diagnosed with Prader Willi Syndrome fall between the moderate and mild levels of an intellectual disability meaning there may be challenges in the area of reasoning, problem-solving, planning, judgment, abstract thinking and learning.  A child or student functioning at the moderate level may lag behind their peers in the area of language and pre-academic skills. Adults may function at an elementary school level and will require support in both work and daily living skills. For children and students functioning at the mild level, there may be difficulties in the area of reading, writing, math and money management. as children grow into adults, there may be a need for support in abstract thinking, executive functioning (planning, prioritizing and flexibility) as well as short-term memory and money management.  Teaching strategies should focus on the following:

  • Aggression management
  • Anger management skills
  • Anxiety management
  • Emotional regulation
  • Personal safety
  • Social skills

Keep in mind that many children and adults diagnosed with Prader-Willi Syndrome may have additional challenges in learning due to medication. Some people take medication such as a growth hormone therapy which can cause fatigue.  The following teaching strategies may also be useful when teaching a student diagnosed with Prader Willi Syndrome:

  • Use a multi-sensory approach. This involves a teaching style that includes auditory, visual, tactile, spatial, and kinesthetic (hands on activities)
  • Break learning into small steps. Check for understanding by asking the student to repeat back to you.
  • Teach a skill at least 2-3 times a day. This will help the student retain information.
  • Managing perseveration. Set up a rule where the student can a question no more than 3 times. After the third answer. Ask the student to repeat the response back to you.
Adult Day Program/Residential Setting

Most people with Prader Willi Syndrome due to their cognitive level, will be provided services in either a day habilitation program or live in a community providing residential services. Once a person becomes an adult, it becomes a little bit more tricky on maintaining issues especially behavioral. For instance, while living at home, a parent has the right to lock the refrigerator which is often suggested by experts. However, this becomes a violations of a person’s rights once they reach adulthood. Typically, committees meet to help make the right decisions along with family members and the adult diagnosed with Prader Willi Syndrome. Here are some suggestions.

  • Allow the person to have control of what is important to them. Have discussions on nutrition and staying healthy. Check to see if this may be an appropriate topic the person may want to improve by adding to their person-centered plan. Hold discussion groups in both day programs as well as in residential to discuss various topics on health and nutrition including holding classes on mindfulness and meditation.
  • Trips to shopping malls can be very tricky. Try to avoid mall’s eatery and plan if it is a group trip to have people bring their own lunches.
  • When teaching, allow time before giving additional prompts
  • Give praise as much as you can when it is appropriate.
  • Use visuals as much as you can including graphics and pictures.
Staff Training

Staff training on Prader-Willi Syndrome should include the following topics:

  • Overview of Prader-Willi Syndrome including, causes, symptoms, characteristics, nutrition, and self-regulation.
  • Impact on the family including the stresses families experience.
  • Teaching techniques including problem-solving, forward shaping and role-modeling.
  • Individual rights
  • Managing behavior and crisis intervention
  • Community inclusion trips and activities
Resources

Foundation for Prader-Willi Research

Prader-Willi Syndrome Association (USA)

Prader-Willi Syndrome (Mayo Clinic)

Reference

Prader-Willi Syndrome Association

 

Speech-language Pathology and Adult Services

speech-word-cloud
Guest Blogger, Anne Marie Pineiro, M.A. CCC-SLP, 

Speech-language Pathologists serve individuals, families, and groups from diverse

linguistic and cultural backgrounds. Services are provided based on applying the

best available research evidence, using expert clinical judgments, and considering

clients’ individual preferences and values. Speech-language pathologists address

typical and atypical communication and swallowing in the following areas:

pragmatics (language use, social aspects of communication)

-literacy (reading, writing, spelling)

– prelinguistic communication (e.g., joint attention, intentionality, communicative signaling)

paralinguistic communication

  • cognition- attention,  memory,  sequencing,  problem solving,  executive functioning
  • feeding and swallowing- 4 phases of swallowing

-oral, pharyngeal, laryngeal, esophageal

orofacial myology (including tongue thrust)

-oral-motor functions

Source:   http://www.asha.org/uploadedFiles/SP2007-00283.pdf

In providing services to those Adults diagnosed with a variety of Developmental Disabilities, the SLP’s role may become much more defined, focusing on what is most functional to an individual in the areas of speech, receptive and expressive language (verbal or non-verbal communication) and feeding/ swallowing.  Very often we are attempting to assess and/or maintain an individual’s current level of functioning in the above areas and to train all those involved in the care of that individual in the strategies and implementation of them to achieve that goal.  In our Agency, for example, we break the assessment down into the following areas in order to develop functional and measurable outcomes:

Speech

  1. Does the individual use speech functionally to communicate wants/needs in a variety of settings?
  2. If so, is their speech understood by all, some, few communicative partners?  Are there any strategies a person might use to increase his/her intelligibility- modifying volume, rate, resonance, increasing fluency, etc.?  Does the person use Augmentative Communication to supplement speech when he/she cannot be understood e.g. low/high tech communication device, writing, American Sign Language, Picture Language Board, etc.

Language

  1. Receptive language (Language comprehension) including attention to objects, using objects functionally, identification of objects and/or pictures, comprehending one, two or three-step oral directives, vocabulary, comprehension of attributes and spatial relationships, or auditory comprehension on the word, sentence and paragraph levels.  Is comprehension on the literal or inferential levels?
  2. Expressive language- (Language expression)- for those who are verbal, the MLU (mean length of utterance) is assessed.  For non-verbal individuals, language expression can be in the form of pointing to one or two picture symbols consecutively on a picture language communication board or AAC device, writing or typing single words, phrases, sentences or paragraphs on paper, computer or AAC device.

-AAC device assessments for nonverbal individuals take into account the individual’s cognitive skills, physical abilities in order to access the device (direct selection with hand or finger, eye gaze, head pointer, switch/scanning, etc.), receptive and expressive language skills, communicative intent and pragmatic language abilities, and literacy.  All those involved in the individual’s care play an extremely important role in whether or not someone may receive an AAC device since they will be the ones to set up/take down the device and provide basic maintenance for the device, including programming, charging, etc.

Feeding and Swallowing:

Many people wonder why an SLP would be the one to review an individual’s mealtime plan or protocol.  ASHA guidelines state it best: “The speech-language pathologist is a primary professional involved in assessment and management of individuals with swallowing and feeding disorders. These areas include:

  • Performing clinical swallowing and feeding evaluation;
  • Performing instrumental assessment of swallowing function with medical professionals as appropriate;
  • Identifying normal and abnormal swallowing anatomy and physiology;
  • Identifying signs of possible or potential disorders in upper aerodigestive tract swallowing and making referrals to appropriate medical personnel;
  • Making decisions about management of swallowing and feeding disorders;
  • Developing treatment plans;
  • Providing treatment for swallowing and feeding disorders, documenting progress, and determining appropriate dismissal criteria;
  • Providing teaching and counseling to individuals and their families;
  • Educating other professionals on the needs of individuals with swallowing and feeding disorders and the speech-language pathologists’ role in the diagnosis and management of swallowing and feeding disorders;
  • Serving as an integral part of a team as appropriate;
  • Advocating for services for individuals with swallowing and feeding disorders;
  • Advancing the knowledge base through research activities.

In addition, Speech-language pathologists have extensive knowledge of anatomy, physiology, and functional aspects of the upper aerodigestive tract for swallowing and speech across the age spectrum including infants, children, and adults (including geriatrics). The upper aerodigestive tract includes oral, pharyngeal, and cervical esophageal anatomic regions. Speech-language pathologists also have extensive knowledge of the underlying medical and behavioral etiologies of swallowing and feeding disorders. In addition, they have expertise in all aspects of communication disorders that include cognition, language, and behavioral interactions, many of which may affect the diagnosis and management of swallowing and feeding disorders.”

Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

The dysphagia and feeding disorders that are seen in adults with developmental disability include poorly developed and absent feeding and oral preparation skills and competencies, physiological and anatomical impairments that degrade oral-pharyngeal and esophageal bolus motility, and disruptive or maladaptive mealtime behaviors. Nutrition, hydration, saliva management, ingestion of medications, and management of the oral hygiene bolus may be involved. Upper airway obstruction (choking), aspiration, malnutrition, and dehydration may result from the disorder (Rogers et al., 1994, Sheppard et al., 1988).  Source: http://www.asha.org/policy/TR2001-00150/#sec1.3

Therefore, in our Agency that serves Adults with Developmental Disabilities, the SLP works as one member of the Team, including the Occupational Therapist, Physical Therapist, Nurse, Residential Team and Family Members to create a mealtime protocol or plan which simply states the best way to maximize nutrition while at the same time attempting to decrease incidents of choking (partial or complete blockage of the airway) or aspiration (food or liquid making its way into the lungs which can lead to aspiration pneumonia).  These plans are developed so that all involved in the individual’s care may be informed of the best feeding practices for that individual which include: adaptive mealtime equipment (any cup spoon, plate, straw, etc. used for an individual to improve ability to eat independently and to improve oral-motor control), positioning in chair or wheelchair, degrees of assistance needed for self-feeding, food and liquid consistencies, food allergies and intolerances, the presence of any mealtime behaviors, including rapid pace of eating which may increase risk of choking or aspiration, and any specific instructions the caregiver would find useful in feeding the individual or maximizing the individual’s ability to feed themselves.

I hope you find this information helpful in identifying the SLP’s role in providing services to adults with Developmental Disabilities.

This information is in no way intended to serve as a complete guide in this area, but is meant to simply assist in identifying ways the SLP works as part of the Interdisciplinary Team in serving adults with developmental disabilities in a day habilitation setting

Lesson Plan: Sensory Activities for Children and Adults

Image result for orange

Orange is a color that is associated with the fall months of October and November. It can also be used as a training activity for people with developmental disabilities.

Facts about the color orange:

  • Orange is the color between red and yellow
  • It is associated with amusement, extroverts, warmth, fire ,energy, danger taste, aroma and autumn
  • It is the national color of Netherlands
  • It is the symbolic color of Buddhism and Hinduism.

Activity: What’s in the Box

Learning Objective: to identify various items using a multi-sensory approach

Activity Area:

  • Visual
  • Tactile
  • Olfactory
  • Kinesthetic

Materials needed:

  • shoe box
  • candy corn
  • carrot
  • orange
  • circus peanuts
  • crayon
  • cheeze-it
  • balloon
  • pumpkin
  • leaf

Instructions: Place all items into an empty container such as a shoe box. Once completed, have participants sit in a circle and pass around the box. Give each person an opportunity to touch the object and to guess the name of the object. For people with a severe cognitive level or multi-disabilities, provide hand over hand guidance.

Prompting:

Discuss with the group or class the various sizes, the aroma, etc.

Alternative Activity:

  1. You can also do a compare and contrast activity by adding items into the box of different colors and having the group choose the orange items.
  2. Have the group create a collage by cutting out items in a magazine that are orange. This will help with improving fine motor skills.

 

 

Art Projects for Disabled Adults

Art therapy allows those who are disabled to have a voice.
Source: EHow

Art therapy can give disabled adults a sense of personal accomplishment, whether they have a mental, physical or emotional disability. Art projects can help to improve a person’s outlook on life, give voice to unexpressed emotions — especially for those with developmental disabilities — or provide a way to make some extra money selling artistic works. When Pablo Picasso said, “Art washes from the soul the dust of everyday life,” he wasn’t just referring to art’s beholders, but those who create it as well. Click here for the rest of the story

Understanding Medicaid Waiver Services

Medicaid.gov - Keeping America Healthy

Home and Community-Based services Waiver allows people with long-term such as disabilities to receive services in a home or community setting. The goal of the waiver program is to enable States to tailor services to meet the needs of a particular group. Standard services can include case management, home health aide, adult day habilitation and respite care. The Federal and State Governments jointly fund and administers the program. At the Federal level, the Centers for Medicare and Medicaid Services (CMS) administers the program. Each State administer its Medicaid program in accordance with CMS approved State plan. Each State is allowed a great amount of flexibility in designing and operation it its Medicaid program as long as it complies with the Federal requirements.

 

Activity Ideas for Developmental Disabled Adults

Board games.
Source: E-How

When it comes to activities, disabled adults have distinctive needs. Unlike average adults, disabled people may require the help of respite workers to do certain activities. However, the needs of disabled adults are not always comparable to those of disabled children because many disabled adults are sexually mature and socially competent. Many activities meet the needs of developmentally disabled adults. Click here to read the rest of the story