1. Juniper Garden’s Children’s Project Kansas Autism Early Intervention Waiver Program Pam Keller, LMSW, Program Manager Department of Social and Rehabilitation Services Linda Heitzman-Powell, Ph.D., B.C.B.A, Director Kansas Center for Autism Research and Training Autism Training Program Jill M. Koertner, M.A., B.C.B.A, Program Director Kansas Center for Autism Research and Training Autism Training Program

2. Juniper Garden’s Children’s Project Objectives Learn to identify gaps in services that fall under the domain of Home and Community-based Services Learn to identify key stakeholders within the autism community in Kansas Receive information regarding the Medicaid Waiver application process Receive information regarding Implementation of a new Medicaid Waiver Be provided with data regarding: Provider Qualifications and professional development Data on the effectiveness of the State required Provider Training

3. Juniper Garden’s Children’s Project Identification of Gaps in Services Families calling Seeking resources Agencies calling (private and public) Children in custody that staff try and identify resources to serve the kids National recognition & research that have identified gaps Home and Community Based Services

4. Juniper Garden’s Children’s Project …….in Kansas Identification of stakeholders Holding focus groups around the state Surveying existing agencies Identify research regarding the topic

5. Juniper Garden’s Children’s Project Identification of Stakeholders Families Governor’s commission on Autism University-based researchers Government agencies, KHPA, Education, SRS, CDDO’s, Mental Health Centers For Autism Services

6. Juniper Garden’s Children’s Project The HCBS Medicaid Waiver Development CMS HCBS application Development of a “large group” of Stakeholders Identify target population Identify and define the services (from Stakeholders) Identify and define service providers and qualifications Identify Training Needs Identify and assemble a smaller work group

7. Juniper Garden’s Children’s Project HCBS Medicaid Waiver Development (cont) Once the small work group was assembled Identification of training components Knowledge of evidence-based approaches Modeling, Coaching, and Feedback on skill implementation Exposure to Job sites currently operating Follow-up Support

8. Juniper Garden’s Children’s Project HCBS Medicaid Waiver Development (cont) Small group continued work including taking the large concept and putting it into practical application Sent application to Centers for Medicaid/Medicare Services (CMS) Approval Began to develop the Autism Waiver Policies and Procedures Manual

9. Juniper Garden’s Children’s Project Program Eligibility Diagnosis - ASD Age—time of diagnosis through their 5 th year Meet Functional eligibility Vineland II Survey Interview Adaptive Behavioral Scale Must be Medicaid Eligible Program Financial Eligibility Only the child’s personal income and resources are considered Parent’s income and resources are not counted Income over $727.00 per month must be contributed towards the cost of care

10. Juniper Garden’s Children’s Project HCBS Medicaid Waiver Implementation News report Family application process Provider recruitment Provider application process Developed Database for Proposed Recipient List Recipient identification (random draw)

11. Juniper Garden’s Children’s Project HCBS Medicaid Waiver Implementation (cont) Recipient Notification (by letter and phone call) Functional Eligibility Specialist (FES) conducts initial assessment to determine level of care Provides provider list Medicaid application

12. Juniper Garden’s Children’s Project Additional Information The institutional alternative for the Waiver program shall be a State Mental Health Hospital and without waiver services the child would be at risk of being placed in an institution. The Waiver began January 01, 2008 25 recipients were randomly selected Additional funding was received in July, 2008 20 additional recipients were added

13. Juniper Garden’s Children’s Project Waiver Services Provided Consultative Clinical and Therapeutic Services (Autism Specialist) Intensive Individual Supports (IIS) Respite Care Parent Support and Training (peer to peer) Family Adjustment Counseling

14. Juniper Garden’s Children’s Project State Requirements for Qualified Providers Consultative Clinical and Therapeutic Services (CCTS)— Autism Specialist Intensive Individual Supports (IIS) Respite Care Parent Support and Training (peer to peer) Family Adjustment Counseling

15. Juniper Garden’s Children’s Project State Approved Training Kansas Center for Autism Research and Training—Autism Training Program KUMC KU Lawrence—Lifespan Institute Juniper Gardens Children’s Project

16. Juniper Garden’s Children’s Project Training Distribution Local Lawrence Kansas City Regional Manhattan Atchison Wichita

17. Juniper Garden’s Children’s Project Online Tutorials Module 1:Autism and Behavioral Treatment Module 2:Defining and Observing Behavior Module 3:Principles of Behavior Module 4:Stimulus Control Module 5:Effective Teaching Strategies Module 6:Decreasing Behaviors: Antecedent Control Module 7:Decreasing Behaviors Using Consequences Module 8:FBA and Behavior Intervention Plans Module 9:Teaching Social Skills with Typical Peers Module 10:Putting It All Together

18. Juniper Garden’s Children’s Project Clinic/Experiential Training Interaction with children in controlled setting Skills modeled by trainers then practiced by trainees Trainees are rated on skill fluency

19. Juniper Garden’s Children’s Project On-the-Job Training Opportunity to observe and demonstrate learned skills in a different professional setting Trainees learn different approaches to behavioral intervention and data collection.

20. Juniper Garden’s Children’s Project Training and Certification Process Receipt of notification of qualification Provider signs up on website Provider is confirmed for dates and receives training materials Completion of on-site/OJT training Receives letter with remaining requirements Submits six 10-minute video clips, on-site observation, or returns to onsite training (KUMC) for follow-up Receives Training Completion Certificate

21. Juniper Garden’s Children’s Project Areas Assessed Online Knowledge Acquisition Pre-posttest knowledge On-Site Skill Acquisition Application of content in hands-on sessions Video-clip Follow-ups Satisfaction Survey

22. Juniper Garden’s Children’s Project Numbers Trained

23. Juniper Garden’s Children’s Project Mastery Criterion

24. Juniper Garden’s Children’s Project Mastery Criterion

25. Juniper Garden’s Children’s Project

28. Program Limitations Only 45 slots available. The service will not duplicate any service included under IDEA or the Rehabilitative Services Act of 1973 (per 1915©)

29. Juniper Garden’s Children’s Project Future Directions Develop component analysis Would allow an evaluation of which components of training require the most time/experience Improve staff training for schools and other agencies Improve the dissemination of best-practice techniques to remote areas