COMMONWEALTH OF PENNSYLVANIA Office of Developmental Programs

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COMMONWEALTH OF PENNSYLVANIAOffice of
Developmental Programs

• BUREAU OF AUTISM SERVICES
• Nina Wall-Côté, MSS, LSW
• Director

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OUR VALUES

• Support for those living with ASD throughout the
  life span.
• Support those living with ASD across the
  spectrum.
• Families need our support.
• Every person living with ASD can have an improved
  quality of life given the right supports
  delivered by trained staff.
• Our goal is to increase independence and
  self-sufficiency.
• Need to explore innovative models.

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OUR BEGINNING

• THE PENNSYLVANIA AUTISM TASK FORCE
• Created by Secretary Richman in 2003
• Comprised of families, professionals and
  educators
• Submitted 1,000 page final report in December
  2004
• The key recommendations from this report drive
  the work of the Bureau of Autism Services

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BUREAU OF AUTISM SERVICESCentral and Regional
OfficesClinical Operational Staff Located in
all Three Regions
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Autism in Pennsylvania 19,951

• 1,400 Adults, 21 years of age and older -
  Served by DPW
• BAS will be looking further at other state
  agencies and facilities to identify adults living
  with ASD.
• 4,377 - Under 21 served by DPW
• 3,940 Under 21 served in the autism category of
  
• special education
• 128 Under 21 - served in another category of
  
• special education
• 5,895 Under 21 - served through DPW and the
• autism category of special education
• 4,211 Under 21 - served through DPW and another
  
• special education exceptionality

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Autism in Pennsylvania
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What the Numbers Tell us

• The numbers in Pennsylvania are consistent with
  the national data.
• Rapidly increasing numbers and we do not
  completely understand WHY.
• Given the low number of adults, we know many
  adults living with ASD were not captured in our
  data.

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People Living with ASD Are In Virtually Every
System

• Education
• Mental Retardation
• Child Development and
• Early Learning
• Early Intervention
• Children, Youth and Families
• Mental Health
• Juvenile/Criminal Justice
• COLLABORATION IS NEEDED BETWEEN ALL SYSTEMS

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Challenges

• Increasing population
• Lack of trained professionals
• Limited resources
• Families stressed
• Need to
• Share responsibility and collaborate
• Address needs across the lifespan
• Look at the entire spectrum, not just those with
  cognitive deficits
• Support families

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SERVICES FOR ADULTS AND THEIR FAMILIES LIVING
WITH ASD

• AUTISM WAIVER - Began taking requests for
  applications
• July 1, 2008 toll free phone number to
  request applications
• is 1-866-539-7689, Option 1.
• ADULT COMMUNITY AUTISM PROGRAM
• (ACAP)
• Written approval received from the Center
  for Medicare and
• Medicaid Services (CMS) in January 2009.
  Program to start
• Spring 2009. Additional information can be
  obtained by
• calling 1-866-539-7689, option 5, then
  option 2, if in
• Pennsylvania, or 717-265-7760, if outside of
  Pennsylvania.

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PA ADULT AUTISM WAIVER AND THE ADULT COMMUNITY
AUTISM PROGRAM (ACAP)

• Both delivery systems will serve adults, 21 years
  and older, living with ASD and their families.
• Both the Autism Waiver and ACAP are assessment
  and outcome driven.
• Assessments inform delivery of services
• Outcome determine measure of success
• Increased hours of employment (paid or volunteer)
• Decreased psychiatric hospitalizations and
  medication
• Decreased involvement with law enforcement
• Improved capacity to perform independently
• Decreased frequency and length of crises
• Decreased family stress
• Both require providers to complete ASD-specific
  training and demonstrate competence.
• Behavioral and crisis support are key services in
  both programs.

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PENNSYLVANIA AUTISM WAIVERFirst Waiver Targeting
Adults with ASD in the Nation!

• Response to key findings of the Autism Task
  Force.
• Specifically designed to meet the needs of people
  living with Autism Spectrum Disorder (ASD).
  Assessment and outcome driven.
• Initial capacity will serve 200 individuals
  statewide.
• Providers are required to complete ASD-specific
  training and demonstrate competence.

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AUTISM WAIVER

• To be eligible
• Live in Pennsylvania
• Have a diagnosis of ASD.
• Age 21 or older by the time of enrollment
• Meet Medical Assistance financial eligibility.
• Meet Intermediate Care Facility level of care.
• Intelligence (IQ) is not considered for
  eligibility.
• Waiver Services may include
• Respite - Family counseling
• Community inclusion - Day
  habilitation
• Supported employment - Family Training
• Job Assessment and Finding - Occupational
  Therapy
• Transitional Work Services - Supports
  Coordination
• Behavior supports - Speech/Language Therapy
• Crisis intervention - Residential habilitation
• Environmental modifications - Nutritional
  consultation
• Counseling - Assistive Technology

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Adult Community Autism Program (ACAP)

• Uses the federal PIHP (Prepaid Inpatient Health
  Plan) funding model used currently by Long Term
  Living one rate paid to one provider for an
  array of services.
• Pilot Program Will serve 200 individuals -
  initially available in Cumberland, Dauphin, and
  Lancaster counties only.
• Additional ACAP programs will be rolled out in
  the future as resources are available.
• Assessment and outcome driven.
• Keystone Autism Services - ACAP provider
  developing provider network to support an
  individuals needs.
• Flexible Offers a team approach, including the
  individual, family, the ACAP Provider and health
  professionals. ACAP Provider and their network
  will offer an established list of services,
  including physician/physical health services and
  services to support the individual in the
  community. Additional services can be provided
  if cost effective and necessary to keep
  individuals living in their communities.

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Adult Community Autism Program (ACAP)

• Designed for individuals
• Age 21 and older
• Diagnosis of Autism Spectrum Disorder
• Be eligible for Medical Assistance
• Be certified as meeting Medical Assistance
  Program clinical eligibility for Intermediate
  Care Facility (ICF) services in the Commonwealth
  of Pennsylvania
• Not enrolled in a Medical Assistance home and
  community based waiver program at the time of
  application

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Adult Community Autism Program (ACAP)

• At the time of enrollment be able to live in a
  community setting without sixteen (16) or more
  awake paid and unpaid staff and supervision hours
  per day without presenting extreme danger to self
  or others or a threat to property
• Does not exhibit levels of extremely problematic
  behaviors that would present a danger to self or
  others or threat to property
• Reside in the service area at the time of
  enrollment
• Not enrolled in a Medical Assistance Managed Care
  Organization (MCO) at the time of enrollment in
  the Plan

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Adult Community Autism Program (ACAP)

• Supports May Include
• Coordination of Supports
• Medical/Physician Services
• Behavioral Health Services
• Respite
• Community Integration
• Support Employment
• Behavior Specialist Services
• Crisis Intervention
• Assistive Technology
• Family Counseling

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Autism Services, Education, Research, and
Training (ASERT) Regional Centers

• Recommendation of the Autism Task Force
• Priority for Families
• Focus on training, applied research, service
  delivery and information dissemination
• Collaborative partnerships
• Needs assessment
• Support to BAS in efforts to build statewide
  capacity

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Autism Services, Education, Research, and
Training (ASERT) Regional Centers

• Autism Services - Ensure that people living with
  autism and their families, in every part of the
  Commonwealth, can access quality supports and
  interventions that are based on best practices
  and provided by trained professionals
• Education Develop educational materials
  relative to ASD and disseminate to families,
  providers and all other stakeholders.
• Research - Research yielding practical and
  measurable results that contributes to the
  enhancement of quality of life for people with
  autism and provide evidence-based information for
  use by families and service providers.
• Training Partners in the development of
  standards and the professional capacity to
  support the needs of individuals with ASD across
  the lifespan.

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PA ASERT Regional Centers

• Bureau of Autism Services
• Nina Wall-Cote, MSS, LSW Director
• [phone]
• Carol Lynch, MBA
• ASERT Project Officer
• [phone]
• Claire Choutka, M.Ed., BCBA
• Clinical Director
• [phone]
• Erica Wexler, Project and Training Coordinator
• BAS Staff Support
• [phone]

• ASERT Contact Information
• Lindsay Lawer, MS
• Director PA Regional ASERT Center - East
• 215-746-6099
• llawer_at_mail.med.upenn.edu
•  
• Shiyoko Cothren, M.H.A.
• Director - PA Regional ASERT Center - Central
• 717-851-7945
• scothren_at_psu.edu
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• John McGonigle, Ph.D.
• Director PA Regional ASERT Center - West
• 412-246-6542
• mcgoniglejj_at_upmc.edu 
•  
•  

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Act 62

• Significant collaboration of the public and
  private sectors producing the most comprehensive
  insurance legislation of its kind.
• Act 62 mandates private insurers to begin
  providing coverage, up to 36,000 annually, for
  the diagnosis and treatment of Autism Spectrum
  Disorders (ASD) for children under the age of 21
  as of July 1, 2009.
• The services and coverage mandated by this bill
  are based on Medical Assistance (MA) definitions
  and standards of care to ensure that essential
  autism services are covered, including those to
  prevent regression.
• Medical Assistance (MA) remains a safety net.
• NEW Web site - www.PAAutismInsurance.org
• EMAIL QUESTIONS TO RA-IN-AUTISM_at_STATE.PA.US

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TRAINING FOR ADULT SERVICE PROVIDERS

• Training Needs of Adult Service Providers
• Few providers are prepared to meet the unique
  needs of adults with ASD across settings.
• Spectrum Training course
• Includes nationally recognized subject matter
  experts and content.
• Consists of nine (9), 45-minute classes.
• Requirement for providers in ACAP and the Autism
  Waiver.
• A CD-ROM version of the training is being
  developed.

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FBA TRAINING

• We have provided regional Functional Behavioral
  Assessment (FBA) Trainings to over 1400 BHRS
  Behavioral Support Consultants (BSCs) and Adult
  Service Provider Staff free of charge with free
  continuing education credits (CEUs).
• Fall 2008 classes are complete
• 2-Day FBA Workshop- 750 more were trained
• 1-Day Advanced FBA training for staff who have
  completed the 2-day FBA workshop-additional 180
  BSCs trained.
• Train-the-Trainer sessions with accompanying
  curriculum and DVD set are being conducted with
  each behavioral health managed care company
  (BHMCO), 8 sessions of 45-60 each total of 360
  trainers trained.
• FBA for TSS Staff Addressing Challenging
  Behaviors
• Downlinked in August to 800 Therapeutic Staff
  Support (TSS) across the state. Training will be
  up on the BAS training website soon.
• Information about additional sessions will be
  posted on our website as it becomes available
  www.autisminpa.org

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SAVE the DATE!

• 2nd Annual Pennsylvania Autism Training
  Conference
• May 27-29, 2009
• Tentative Location
• Lancaster, PA
• Watch www.autisminpa.org for details!

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Continuing Education

• The Bureau of Autism Services is an approved
  provider of continuing education credits for
• Educators (Act 48)
• Social Workers
• Board Certified Behavioral Analysts (BCBA/BCABA)
• Psychologists (APA)
• National Board of Certified Counselors (NBCC)

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FAMILY ISSUES

• All families are unique
• Isolation and overwhelming stress
• Families have difficulty navigating the system
• Raising a child with ASD can be lonely, children
  do not have many friends, siblings may feel left
  out
• Significantly higher divorce rate in marriages
  for parents of children with ASD
• Parents may have to quit job or reduce hours to
  care for the child or adult with ASD
• Parent groups are a great source of support,
  information and community

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SUPPORT FOR FAMILIES

• Family and Individual Support Grants
• Families apply for up to 500 to assist with
  respite care, community inclusion, home safety
  modifications, summer programming, etc.
• Based on feedback received from the autism
  community over the past two years, the mini-grant
  program has had meaningful impact on improving
  the quality of life of individuals and families
  living with ASD.
• 2007 - Awarded over 1,300 PA families a total of
  650,000 in 500 mini-grants
• 2008 BAS funded more than one million dollars to
  support over 2,000 families.

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BUREAU OF AUTISM SERVICES ADVISORY BOARD (BASAB)

• The BASAB is comprised of family members,
  self-advocates, professionals, and advocates.
• Members have been appointed by the Secretary for
  Public Welfare and serve three-year terms.
• Serve a vital role in linking the Bureau to the
  larger Pennsylvania autism community and will
  provide valuable input to BAS on important
  initiatives.
• Actively engaged with the ASERT regional centers.
• Provide advice on the initiatives, programs,
  policies, and budget of the Bureau of Autism
  Services offering input regarding the Bureaus
  strategic plan.

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Biopsycho-Social Unit Western Psychiatric
Institute and Clinic (WPIC)

• Part of the University of Pittsburgh Medical
  Center
• Pilot program serving children/adolescents and
  adults with ASD who can not be served by local
  medical/psych resources
• complex medication assessment issues
• co-morbid medical assessment needs
• multiple diagnosis issues
• program includes added training to support
  careful return to school, home, and community
  providers
• admission coordinated with BAS clinical office

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Bureau of Autism ServicesNina Wall-Cote,
Director

• Email us at
• DPW-AutismOffice_at_state.pa.us
• Visit our Website www.autisminpa.org
• Contact us at 717-265-7760 or
• Toll Free in Pennsylvania at
• 866-539-7689