Anna's Blog

Archive for February, 2012

Therap is tickled…ORANGE…to welcome the State operated programs in Washington. Three programs have joined Francis Haddon Morgan Center under the Washington umbrella. These include SOLA (State Operated Living Alternatives), Crisis Intervention Services, and Yakima Schools.

Welcome Saif, Carol, Tammy, and all of the Washington State Department of Social and Health Services to our growing number of States, Counties, and providers across the Nation! We look forward to working with you!

The KC Regional Conference is quickly approaching May 22-23. For those of you kinda sorta thinkin’ about coming…what are you waiting for? This conference is designed to answer questions and provide training for new and seasoned agencies alike. To make it even more fun, we are hosting the conference at the Holiday Inn CoCo Key Water Resort (how cool is THAT?!).

Don’t waste anymore time deciding – get over to our website and Register today.  Hope to see you there!

I know…for some of us this is a blissful picture…for others…not so much. Here in Oregon, this pretty shot of the hole later became a wet and soupy view of the green as rain hit us about the 4th hole and continued through the 9th. At that point I picked up my ORANGE golf ball and called it a day.

After leaving San Antonio last week, where the temperatures were PERFECT for golf, I came home and pleaded with Nick to take me out and play this weekend (let’s just say…I barely had to say G-O-L-F and he was pulling out his sticks and making sure he had enough tees to get through a a round).

Despite the rain and somewhat cool 45 degree temperatures, I played pretty well for my first time out this year. Not a single drive left the fairway, I didn’t lose my Therap golf ball, never hit a bunker, and I kept the whiffs to a total of two. I’m still going to have to get my short game squared up over the next few weeks but all-in-all I left the course pretty darn happy with my game. Whoo Hoo!

Hope you get a chance to get onto your favorite course soon.

Ever have one of those days that you look at your Dashboard and you just think to yourself, “I LOVE Therap!!!!”? Well, for those amazing and wonderful Therapites out there (and we have many!) who are having an I Heart Therap kinda day….here you go -

Make this your screen saver and show the whole office that you are a fan! Have a terrific weekend. I will see you next week!

I came across this article today. It is of special interest for Therap users that serve individuals with Autism and upcoming changes to the DSM-V. Check it out!

Changes in Classification of Intellectual Disability and Autism Spectrum Disorder
Ellis M. (Pat) Craig, Ph.D., AAIDD Texas Chapter Past President

Some significant changes lie ahead in the diagnosis and classification of Intellectual Disability (ID) and Autism Spectrum Disorder (ASD). This is a result of the imminent publication of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM V). The various editions of the DSM have been the standard adopted by most governmental agencies, insurers, and clinicians around the world for the diagnosis of mental disorders. It has been incorporated into the World Health Organization’s International Classification of Diseases (ICD) along with physical disorders. The eleventh edition of ICD is expected to be published at about the same time as the DSM V, in 2013. Both ID and ASD are included in a major category called neurodevelopmental disorders in the new DSM V structure.

Although the DSM diagnostic criteria and classification categories for ID (or earlier-used terms) has generally been consistent with those published by the American Association on Intellectual and Developmental Disabilities (AAIDD) in its various editions of terminology and classification manuals, there have been some key inconsistencies, in part because of varying publishing dates. For example, DSM IV continued to focus classification entirely on IQ ranges, with only passing reference to the importance of adaptive behavior in diagnosis and classification.

A concerted attempt has been made in the DSM V drafts to incorporate the latest thinking in diagnosis and classification of ID. For example, while intellectual assessment is still necessary for diagnostic purposes, classification and diagnostic coding will be based on the level of adaptive functioning in three domains: social, conceptual, and practical skills. The severity level classifications to be used have not been shared yet on the website. However, there is a separate diagnostic code of “intellectual or global developmental delay not elsewhere classified” designed to be used for very young children or in instances when required assessments cannot currently be completed.

The stronger emphasis on adaptive skills is consistent with, and, in fact, was originally proposed by AAIDD. However, AAIDD has expressed some concerns with the DSM V draft. For example, DSM names the disability “intellectual developmental disorder” rather than “intellectual disability”, the term now most widely in use around the world. Although the diagnostic criteria in terms of IQ scores is consistent with AAIDD’s (2+ standard deviations below the mean on a standardized intelligence test – an IQ of 70 or less), AAIDD has placed more emphasis on considering psychometric properties of tests and sometimes allowing scores up to 75 to be eligible. Further, despite the shift in focus by DSM to adaptive behavior, no psychometric criteria are specified. Use of standardized scales is recommended by DSM, but the 2+ standard deviation criterion advocated by AAIDD has not been incorporated at this point. The DSM-proposed classification system of adaptive skills is likely to suffer from inter-rater reliability problems. Finally, in its latest edition of a terminology and classification manual, AAIDD had recommended movement toward a multidimensional classification system (Intellectual, adaptive behavior, health, participation, and context). This approach has not been incorporated in the DSM V draft.

Thus, the major changes that DSM V, if unchanged from the draft, will elicit will be a de-emphasis of IQ scores, a more subjective rating of adaptive skills, and different terminology. There may be very serious implications in forensic settings if psychometric adjustments of acceptable IQ scores are not advocated. It could even have negative implications for service and benefits eligibility.

A similar outcome may result from the changes proposed for Autism Spectrum Disorder (ASD). Whereas DSM IV, under the general category of Pervasive Developmental Disorders, included separate diagnoses for Autistic Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified, these are all combined into a single diagnosis of Autism Spectrum Disorder (ASD) in DSM V. The rationale for this diagnostic unification is that distinctions among the four disorders have been inconsistent and often based on variables other than criteria for the diagnosis (e.g., intelligence). It is the DSM V position that ASD is defined by a common set of behaviors and is best represented as a single diagnostic category.

Another major change from DSM IV to DSM V in the diagnosis of ASD is that the three major criteria have been combined into two. Specifically, qualitative impairments in (1) social interaction and (2) communication are now reflected as a single criterion of social/communication deficits. The rationale is that deficits in communication and social behaviors are inseparable. The second major criterion remains fixated interests and repetitive behaviors.

Thus, to receive an ASD diagnosis there must be social/communication deficits or “persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays” (DSM V draft). Further, there must be deficits in all 3 of the following areas: (1) social-emotional reciprocity (e.g., lack of social interaction), (2) nonverbal communicative behaviors used for social interaction (e.g., lack of eye contact), and (3) developing and maintaining relationships (e.g., lack of interest in others).

With regard to the second major criterion of fixated interests and repetitive behaviors, at least 2 of 4 of the following must apply: ” (1) stereotyped or repetitive speech, motor movements, or use of objects, (2) excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change, (3) highly restricted, fixated interests that are abnormal in intensity or focus, and (4) hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment” (DSM V draft). In addition to meeting the two major criteria, the symptoms must be present in early childhood and must limit and impair every day functioning.

It is suggested that the new, single diagnosis reflects a continuum of symptoms ranging from mild to severe, but that its specificity will allow more accurate diagnosis of this disorder. It is also noted that field tests have not indicated that there will be any change in the number of individuals receiving the diagnosis. However, one should probably be skeptical of this assertion, especially concerning individuals who received the DSM IV diagnosis of Pervasive Developmental Disorder Not Otherwise Specified. Eligibility for that diagnosis only required the existence of social impairment due to communication problems or stereotyped behaviors. There has also been concern raised about the continuing eligibility of persons previously diagnosed with Asperger’s Disorder. This is not to discount the value of the DSM V authors’ attempt to improve the validity of the ASD diagnosis. It is simply recognition that eligibility for services or benefits under this diagnosis are likely to become more rigorous.

No, its not a rumor. I can tell you that in the next few months Therap will have a team member based in the State of Texas….namely, ME…and NO, I’m not abandoning any of my current NW Coast Therap customers…its simply a move we feel is necessary to better respond to the needs of our Texas customers and grow our services in the State.

Where, specifically will our new “office” be located? At this point lets just call it…Somewhere, Texas…because the jury is still out on the exact city that Therapville will inhabit.

I can tell you that we’ve narrowed it down to Houston (its close to the water) or Austin…but after a nice chat with Nancy Newberry (American Habilitation) I think I’m leaning toward the Austin area. I’m told its only 3 hours away from really beautiful water (North Padre) and there are a number of lakes nearby that we will be able to enjoy during down time (provided there is cell coverage and electricity). SOOOO….stay tuned. I’ll be doing my own mini-version of “House Hunters – Texas” and you are welcome to come along for the excruciating…I mean…exciting ride.

I am not good with goodbyes. I simply don’t like ‘em. Such is the case today as I depart the APDDA Conference, saying goodbye to both old friends and new. Maybe the greatest sadness will be the departure from the 70 degrees of GORGEOUS weather that San Antonio bestowed upon all of us these past few days. If only I had brought my golf clubs! Darn!!!!! But that did remind me of a joke I heard yesterday. We were talking golf handicaps. One director said his was -2 and another said his was in the double digits. The third director chimed in and said that his golf handicap….was his swing. I don’t quite know why that tickled me but I thought it was really funny…perhaps because it hits a bit too close to home.

To Judi- I promise to help Gatesway be the best Therap user in all of Oklahoma. We’ll get ‘er done Chica!

A special note to my friend, Scott Umbreit, Executive Director of APDDA – Thank you for remembering my love of the Oregon Ducks again this year. I will take very good care of the goodies that “Santa” brought to me. You are top notch in my book and an all-around awesome person! Looking forward to seeing you and Bert next year!

Right away its felt like a hometown reunion! Stacey Cloud and two of Home of Hope’s team members greeted me with hugs and a request to take a picture with their travelling gnome. Being the good sport that I am, I happily agreed…so  did Ther-Bear. He loves any opportunity to get in front of the camera.

Judi Myers (Gatesway Foundation) looks over her schedule BUT look who she has at the table with her...its THER-BEAR!!!! How cool is that!

Therap has a new agency in Oregon…go figure! SISO (Supported Independence Services Of Oregon) has joined the Therap family and we are mighty happy that they did!

SISO is a community based organization, that provides innovative residential adult foster care services to intellectually and developmentally disabled adults in Lane County.  SISO opened their doors in 2006 with the purchase of one family home and a contract to serve one individual and 0 employees. The agency has been very successful supporting highly challenging individuals, and has continued to grow their organization out of their passion to provide the best possible individualized supports based around positive behavior supports and the principle of self determination. The company currently operate 5 homes and support 24 people with over 50 employees. Their focus is twofold: 1.) To provide the highest quality person centered services that meet the complex and changing needs of the supported individual. 2.) To ensure that everyone, regardless of ability, reaches their full potential in safe, supervised settings.

Therap is excited to be working with Jackie, Mark, Mary and the SISO team to improve their documentation expectations and increase quality in their services.

Welcome SISO family to the Therap family! Allison and I look forward to working with you!!!!!

If your calendar has you at the APDDA Conference in San Antonio, TX. this coming week, you should give me a call because I will be there too! Yep, Therap will be at the conference (February 19-22) with Directors from across the Nation discussing a number of topics near and dear to our hearts…and our minds. Some of these include:

•  Person Centered Dynamic Risk Manageability

•  State Developmental Disabilities Directors Panel

•  Resource Centers: Crisis Stabilization

•  Resource Centers: Creative Financing

•  Emerging Trends and Issues in DD Systems across the United States

•  CMS Expectations & Focus of State Surveyors

 The Association of Public and Private Developmental Disabilities Administrators (APDDA) is a not for-profit professional organization founded in 1970. The Association represents organizations across the United States.  APDDA is the only national organization that focuses on the unique issues of administrators of public and private ICF/MR programs.  APDDA also provides support for other individuals with interests in the field of intellectual and other developmental disabilities. The Association supports the continuous improvement of a comprehensive array of individual and accessible services designed to enhance the quality of life for persons with intellectual disabilities and other developmental disabilities.

Hope to see you there!