TheraTree Pediatric Therapy - TheraTree Blog by Jessica

KY Medicaid Annual Renewals

Sat, 03 Jun 2023 11:31:27 -0500

Avoid Loss Of Medicaid Coverage

The Kentucky Department for Medicaid Services (DMS) is resuming annual Medicaid renewals which may effect your child's coverage. During the COVID-19 Public Health Emergency, DMS stopped all annual renewals to facilitate Medicaid beneficiaries keeping their coverage during the Emergency. Because the Public Health Emergency was ended at the federal level, annual renewals have resumed. This blog has important information to help prevent patients from losing Medicaid coverage.

Critical Bottom Lines:

Medicaid must have your current and up to date information to avoid loss of coverage. If your contact information has changed or is incorrectly listed, you may miss your notification of renewal. Verify and update your mailing address, phone number, email and other contact information as soon as possible by visiting kynect.ky.gov or calling 855-459-6328.
If your child's benefits are managed by an MCO your child may have a change of coverage during their review whether passive or actively renewed. Currently, MCO's are holding KY Medicaid accountable for coverage during the review period. Therefore if a healthcare service is provided during this review and the provider is unaware of your review, your service may be denied due to no prior authorization. Medicaid has yet to provide a mainstreamed solution for coverage during the renewal process.

Different Renewal Requests and Actions

Passive Renewals: Members who have up-to-date and verifiable information in the system can be passively renewed. This means that Medicaid has all information necessary to make an automatic renewal determination within their records to ensure they remain eligible. These individuals will receive a Notice of Eligibility and will not need to act. The Notice of Eligibility notifies a member that their coverage has been continued.

Action Required for Renewals: Members that are missing specific pieces of information will receive a Request for Information (RFI). A RFI requests additional information to support Medicaid in accurately determining a member’s eligibility. Members who receive a RFI must respond to the RFI prior to their renewal due date to ensure their renewal can be accurately and timely processed.

Additional Action Required for Renewals: Members in which Kentucky Medicaid requires more information from the member because they cannot be passively renewed by the system will receive a prepopulated Renewal Packet. A Renewal Packet requests additional information from the member to be updated within kynect. This information must be submitted prior to their renewal due date to ensure their renewal can be accurately and timely processed and coverage can continue.

Different Renewal Requests and Actions

Members renewal and redetermination date, timelines, and status information is available on kynect in your benefits page.

April 2023: Initial notices of renewals sent to individuals enrolled in Medicaid.
May 2023: Renewal process has restarted.

90 days prior to member’s end date, members will receive an email and SMS communication from the state that their renewal is upcoming.
50-60 days prior to member’s end date:

The state will attempt to automatically renew a member’s benefits.
In cases where Medicaid cannot automatically renew benefits, 50-60 days prior to member’s end date notices will be sent out. This means that members will receive notices within the first 2 weeks of a month before the month of their end date.
If there has been no response from a member by the 15th of the month of their end date, members will receive follow up outreach to request response and information.

End Date of Coverage:

It is important for members to provide all requested information before their renewal date to avoid discontinuation of coverage.
Coverage will end for members who are determined to be no longer eligible on their posted renewal date.
Members who do not respond to requests for information or submit their renewal packet information may also be determined ineligible based on lack of information.

April 2024: All initial renewals will be complete and additional annual renewals will continue to occur.

Download Instructions for Viewing Your Renewal Date

Important Communication

The most important action is to update your contact information in kynect (https://kynect.ky.gov/). Submit multiple ways to be contacted by Medicaid within their kynect profile (e.g., home address, email address, phone number).

All communications will come from the state Cabinet for Family and Health Services (CHFS) and the Department for Medicaid Services. Check your communication preferences on kynect.

Postal Communication: If you have opted in for paper communications, this will come via postal mail.
Digital Communication: If a member is opted in for digital communications, the notice will be shown in their message center and an email and/or SMS will be sent.

Opt in to receive email and SMS messages on your kynect account as well as with your health plan to ensure you receive all information in the most efficient manner.
Other providers or representatives from your health plan may reach out about your upcoming renewal, but any request for information (RFI) or Medicaid renewal packet will only come from the state.
Please note that the state is exempt from the Telephone Consumer Protection Act when communicating with members about their benefits.

Ways to get Information:

Kentucky PHE website: https://medicaidunwinding.ky.gov

If there are specific questions about the Medicaid renewal process, Medicaid members can access information sheets and guides here.

Monthly Stakeholder Meetings:

Every third Thursday at 11:00 EST.
You can register for the June 15, 2023 session through this registration link.
If you have any questions for DMS that you would like for us to speak to during the upcoming monthly meeting, please submit those questions through this survey.

CHFS’ social media accounts: Facebook, Twitter, Instagram
Kynect Hotline: 855-4kynect

How to Renew

Information can be submitted in various means. Members will receive a notice that only requests the information necessary, based on their specific situation, to make a determination. The types of documents needed will be clearly communicated to the member.

1. Complete and Return Forms:

Fill in all requested information
Return by fax to 502-573-2005 or 502-573-2007
Return by mail to P.O. Box 2104, Frankfurt, KY 40602

2. Self-Service Portal:

Log in to kynect at https://kynect.ky.gov/benefits
Click on Review Benefits or upload requested information in RFI

3. Connecting with kynect or DCBS:

Kynect

Hours: Mon-Fri 8:00 am to 4:30 pm ET
Call (1-855-459-6328)
Find and visit a kynector or agent office HERE.

DCBS

Hours: Mon-Fri 8:00 am to 4:30 pm ET and Saturdays from 9:00 am to 12:00 pm ET
Call (1-855-306-8959)
Find and visit a DCBS office HERE.

Download kynect benefits FAQ

Income Verification: If verification of income is requested, Documents are required for proof of income and will need to upload any of the following:

Wage stubs
Written statement from or a collateral contact to the employee
Previous year tax return
Award letters for things such as Retirement, Survivors, and Disability Insurance (RSDI) or Unemployment Insurance Benefits (UIB)
The state’s various data sources such as eligibility advisor or state wage data for the previous quarter
Personal records for those who are self-employed
“No income” status can be verified through client attestation, through collateral contact to a non-household member, a signed written statement from a non-household member, or Form PAFS-702, Proof of No Income.

Social Security Disability Insurance

The Medicaid renewal process will impact members who currently have Medicaid and are on SSDI. Medicaid will attempt to determine individuals on SSDI Medicaid eligible in another category. If Medicaid is unable to make this determination, the member will be determined ineligible and will receive a termination notice (will no longer receive Medicaid benefits).

MCOs

MCO partners will conduct outreach to members who have received a redetermination package or a request for information from the state. MCOs will help members understand what actions they must take and connect them to navigators or kynectors to provide additional support or guidance, as appropriate. MCOs will outreach to individuals administratively terminated for up to 90 days after their end date to encourage they submit information.

A member submitting required information and determined eligible within the 90 days will have coverage retroactively reinstated to their end date. MCOs will also outreach to members who have been determined to no longer be eligible for Medicaid to support them in identifying alternative health care coverage options such as a Qualified Health Plan on kynect.

Waiver Participants

Appendix K Waiver flexibilities will extend 6-months beyond the end of the PHE May 11, 2023 extending waiver flexibilities to November 11, 2023. This extension is to allow 1915(c) HCBS waivers return to normal operation. Appendix K cannot remain in place beyond its approval end date. To make Appendix K updates permanent, changes would need to be incorporated into the current waiver applications and submitted to CMS for approval. Additionally, waiver-related Kentucky Administrative Regulations must be updated and approved.

All waiver participants will go through a redetermination during the 12 months. For detailed information, please see the 1915(c) HCBS COVID-19 and Appendix K FAQ. There is an outreach plan to support waiver members through the PHE unwinding period. Kentucky is actively preparing for the future of our waiver programs to ensure we continue to support waiver participants as well as possible.

Ineligibility & Disqualifications

If a member is determined to no longer be eligible for Medicaid, they will receive a discontinuance notice that fully explains the reason for no longer being eligible. The discontinuance notice will also indicate the options to appeal the decision.

All members have a right to appeal if they do not agree with the decision. Members who have been determined ineligible have 90 days from their Medicaid renewal due date to submit all requested information and be determined eligible for Medicaid coverage. Their coverage will be reinstated back to their end date automatically. If a member submits the requested information and application within 90 days from their Medicaid renewal date and is determined to be eligible, they will have their Medicaid reinstated back to their end date automatically. If a renewal is pending for state action at the time of the member’s renewal date, the member’s coverage will be extended until a determination is made. If no longer eligible, the member’s coverage will end on the first day of the following month.

Animal Assisted Therapy

Mon, 29 May 2023 13:08:00 -0500

Animal Assisted Intervention

Our Animal Assisted Therapy program has begun with Bo the Certified Therapy Dog!

Animal Assisted Intervention (AAI): An alternative or complementary type of therapy intervention that includes the use of animals as a means to deliver therapeutic intervention in a treatment. Animal-assisted interventions are goal-oriented and structured interventions that intentionally incorporate animals into health, education and human service for the purpose of therapeutic gains and improved health and wellness. There are three specific delivery methods of AAI:

Animal-assisted therapy (AAT)
Animal-assisted education (AAE)
Animal-assisted activities (AAA)

Animal Assisted Therapy

Animal Assisted Therapy (AAT) is a complimentary type of therapy intervention; meaning, it’s added and incorporated into the child’s existing therapy plan of care and goals. The therapy clinician determines if using AAT will help forward progress of your child’s current established goals. If the clinician and family agree that AAT could be beneficial for the child, the clinician will create the therapeutic interventions within their scope of practice that are goal-oriented, planned, structured, documented, then invite the certified Therapy Dog and it’s certified handler to the appointment.

Examples of AAT:

A child learning to button dresses up the dog in a button down shirt.
A child working on speech skills gives the dog commands like “sit” or “stay”.
A child who is afraid of heights jumping with the dog from a platform.

Key Features of AAT:

Must be overseen by a health and human service provider as part of their profession.

A wide variety of disciplines might incorporate AAT include physicians, occupational therapists, physical therapists, certified therapeutic recreation specialists, nurses, social workers, speech therapists and mental health professionals.

Must incorporate the animal as part of his or her own specialty.

Clinicians acknowledge and work within their own level of competence, education, licensure, and skill set.
Example: A social worker must incorporate the animal in the context of social work. If the same social worker takes the animal to visit a group of children on an informal basis, the visit would be considered AAA, not AAT.

Interventions are planned and goal-directed.

Activities and interactions with animals are goal-specific and measurable, such as improvement in range of motion or fine motor skills.
The goals must be identified and defined in the plan of care before the session or the session can't be considered AAT.
The activities may or may not include direct contact with dog.
The focus of treatment is on the therapeutic process and outcomes. This may include the set-up, planning, and organizing of activity, additional preparation for dog, rather than just completion of a task.

Documented and Billed.

Each session is documented in the client's record, with the activity and progress noted.

Because AAT is incorporated into an existing skilled therapy treatment (not a separate service) the intervention is billed as usual to insurance reflecting the purpose of the intervention.

Animal Assisted Education

Animal Assisted Education is a goal-oriented, planned and structured intervention directed by a general education or special education professional. The focus of the activities is on academic goals, prosocial skills and cognitive functioning, and student progress is both measured and documented.

Key Features of AAE:

Overseen by a credentialed general or special education teacher.
Planned and goal-directed.
While any visit with an animal might be beneficial for a student, unless the goals are identified and defined before the session, the session is not considered AAE.
Documented in an educational setting this may mean it is part of a specific lesson plan or has an associated assessment which documents student progress.
In special education, it may be part of an Individualized Education Plan.

Examples of AAE:

Classroom presentation as part of a unit on responsible pet ownership.
An elementary school coordinates a reading program for youth with speech impediments to practice reading aloud to animals. The session is supervised by the speech therapist who records student progress.

Animal Assisted Activities

Animal Assisted Activities provide opportunities for motivational, educational and/or recreational benefits to enhance quality of life. Although these activities are more informal in nature, they’re delivered by a specially trained professional, paraprofessional and/or volunteer in partnership with an animal.

Key Features of AAA:

This does not occur during a healthcare type setting - this is not the type of intervention completed at TheraTree
Specific treatment goals are not planned for each visit
Content is spontaneous and may only last a few minutes

Examples of AAA:

Volunteer type situations at events, or meet and greets
Animal interacts with a non-patient in a healthcare setting
Although the term “pet therapy” was widely used several decades ago, it should be avoided, because it’s inaccurate and misleading. The currently preferred terms imply that the animal is acting as a motivating force to enhance the treatment provided by a well-trained person.
Animal-Assisted Crisis Response (AACR) A subset of animal-assisted activities, animal-assisted crisis response provides comfort to those who have been affected by natural, human-caused or technological disasters. The response environment has the potential to be complex and unpredictable.
Animal-Assisted Workplace Well-Being (AAWW) A subset of animal-assisted activities, animal-assisted workplace well-being incorporates therapy animal interactions in workplace settings, for benefits that range from stress reduction and decreased blood pressure to socialization and community building, along with the potential for increased productivity.

Benefits

The goal of animal-assisted intervention is to address and improve a patient's goals which may including but not limited to the following:

The Human-Animal Bond (HAB)

A mutually beneficial relationship between humans and animals. Animal-assisted interventions exist because of the power of the bond which has beneficial psychological and physiological outcomes for participants. While we often focus on the benefit to humans receiving AAl, it's important to remember that animals also experience benefits from their relationship with humans. It has been found that companionship and social support helps pets and animals live longer, healthier lives.

Physical

Fine and gross motor skills
Wheelchair skills
Standing balance

Cognitive

Attention skills
Sequence

Empathy

Identifying with and understanding the feelings and motives of others. Studies report that children who live in homes where a pet is considered a member of the family are more empathetic than children who live in homes without pets. Children might see animals as peers. It's easier to teach children to be empathetic with animals than with humans, because most animals have such straightforward body language. As children age, their ability to empathize with animals generally carries over into their experiences with people.

Outward Focus

Bringing individuals out of themselves. Interactions with animals can help people who tend to focus on themselves pay more attention to their environment. Instead of thinking and talking about themselves and their problems, they can watch and talk about the animals.

Educational

Increase vocabulary
Aid in improving long- or short-term memory
Improve knowledge of concepts such as size and color

Nurturing

Promoting the growth and development of another living thing. Nurturing skills are learned. By being taught to take care of an animal, children who haven't learned nurturing skills through other channels can develop them. Furthermore, a person who is engaged in nurturing activities is also, to some extent, fulfilling his or her own need to be nurtured.

Rapport

Building a relationship of mutual trust or a feeling of connection or bonding. In therapy settings, the presence of an animal in the therapist's office can help clear a path through the client's initial resistance and open a channel of emotionally safe, nonthreatening communication between the client and the therapist. Children are especially likely to project their feelings and experiences onto an animal.

Acceptance

Offers favorable reception or approval. Animals have a way of accepting without qualification. They don't care how a person looks or what the person says. An animal's acceptance is non-judgmental, forgiving, uncomplicated and unconditional.

Socialization

Seeking out or enjoying the company of others. Studies have shown that when dogs and cats come to visit a care facility, there's more laughter and interaction among residents than during any other entertainment or therapy time. In an inpatient setting, the presence of animals encourages three types of socialization:

1. Among clients
2. Between clients and staff
3. Among clients, staff, and family members or other visitors

Mental Stimulation

Occurs because of the opportunities that animals provide for communicating with other people, recalling memories and entertainment. In situations that are depressing, the presence of animals serves to brighten the atmosphere, increasing amusement, laughter and play. These positive distractions might help decrease people's feelings of isolation.

Physiological Benefits

Much has been written about the correlation between touch and health. Infants who are touched very little might have difficulty developing healthy relationships with other people and might fail to thrive and grow physically. For some people, the touch of another person isn't acceptable, but the warm, furry touch of a dog or cat is. In hospitals, where most touch tends to be painful or invasive, the touch of an animal is safe, non threatening and pleasant. In many programs for people who have been physically or sexually abused, staff members and volunteers aren't allowed to touch the clients. In these places, having an animal to touch, hold and hug can make a world of difference to people who would otherwise have no positive, appropriate physical contact.

Motivational

Positive effects on the basic functioning of the body. Some consider a biopsychosocial framework for AAT, since it affects clients on biological, psychological, and social/environmental levels (Blazina, Boyraz, & Shen-Miller, 2011). An extensive amount of research shows the medical benefits of spending time with animals. The Centers for Disease Control and Prevention list some benefits as: Lowered blood pressure, Lower cholesterol, More likely to exercise, Lowered risk of diabetes, Lowered cortisol (Fine, 2019a). In fact, oxytocin (the “love hormone”) plays a large part in our connection to animals. Oxytocin is the hormone that is released to help parents bond with their children and when people fall in love. It helps us feel good and allows us to feel emotionally secure, content, and happy. Oxytocin also increases in humans when we spend time with animals; we naturally feel better when they are around (Compitus, 2021a). Tests have shown that the decrease in heart rate and blood pressure can be dramatic.

Request Animal Assisted Intervention

If you would like to Animal Assisted Therapy to be included in your child’s therapy:

Email Contact@theratreepeds.com
Discuss AAT with your child’s therapy clinician at your next appointment.

Qualifications of Animals & Handlers

At TheraTree we have a commitment to excellent and evidence based care. Therefore, it’s our policy for clinicians to first complete a 5 hour Animal Assisted Therapy continuing education training which is free, internal, a credit toward required state CEUs, and at their own pace before incorporating AAT into treatment.

Handler Standards:

Must be the active handler during the dog's certification tests and maintain certifications.
Handlers must be able to act quickly enough to remove themselves and their dogs without assistance from a facility in the event of an emergency.
Must maintain Current Animal First Aid Certification
Must maintain professional liability insurance.

Animal Behavior Standards:

Must complete the following standardized behavior certificates.

AKC Canine Good Citizen Certified
AKC Community Canine Certified
AKC Urban CGC Certified
Alliance of Therapy Dogs Certified

Must pass on site competency by TheraTree’s AAI Coordinator
Affect: enjoyment, relaxed, confident, focused
Interactions: welcomes attention from stranger, interaction in suitable ways, neutral when encountering other dogs, maintains good communication with handler,
Obedient: exhibits self control, reliable, predenticle, controllable, responds to basic obedience cues.
Safe: maintains loose leash, stay close to handler, licks only when cued, doesn’t vocalize,
Equipment: Must have all the required equipment to promote safety and wellbeing.
Leash: Maintains safe and close leash walking behaviors.

Animal Health Standards:

Current on vaccination and certification of health by their veterinarian including: Bordatella (kennel cough) vaccine, Distemper, Adenovirus, Parvovirus, +/- Parainfluenza, Canine influenza, Leptospira, Lyme disease, Rabies (Titer levels of 0.5 IU or greater are acceptable and must be measured every two years to ensure levels are acceptable.)
Must be free of any signs of ill health while in the clinic. Animals with physical and medical disabilities must have veterinarian approval documentation that their disability does not pose harm or a safety risk to themselves or any other staff or patient in the clinic. Participation must not compromise the animal’s health and wellbeing.
Dogs must be clean and well groomed. (See AAI requirements for specific definitions)
Must be non-shedding.

The goal of animal-assisted intervention is to address and improve a patient's goals which may including but not limited to the following:

Preschool Readiness: What Parents Need To Know

Fri, 20 May 2022 19:21:59 -0500

By Jessica Hatfield, MS, OTR/L

Preschool is a big step for both parents and child! As a parent of a 3 year old you might be wondering: “Is my child ready?” “Did I do enough?” “Can we please start tomorrow?!?”. Whichever space you’re in is fine! If you learn you child is on track - great! If you learn your child might need some more help - great! Now you know and can take actions on catching them up to their peers.

It’s important to keep in mind that preschool is more about emotional and developmental readiness than knowing and writing all their numbers and letters. Those traditional educational/cognitive skills can be further taught through preschool. Developmental milestones are critical to establishing your child’s confidence and self esteem. Children who do not perform developmentally appropriate tasks may struggle with preschool. While it doesn’t mean they can’t attend preschool, they may need extra help now to prepare and catch up to their peers from therapists who specialize in child development like at TheraTree.

Here are the big five areas we help parents look for: Emotional, Motor, Independence, Language, and Cognitive Development

Emotional Development

Separation: Most children who are emotionally mature are eager to go to school and make friends. They can emotional handle being away from you for short periods of time. The unknown of how the first day will go might be the most nerve racking part for parents. While it is normal for a preschool to be a little apprehensive or upset while saying goodbye the first day or even week, when they continue to be upset throughout the day it become a problem. A child who demonstrates fear, anxiety, worry, panic, or meltdowns when separating are clear red flag they need some extra support developing their emotional maturity. How to test this: Practice separation. Start with a short period of time (30 minutes) and work up to longer (4 hours). Drop them off at a trusted neighbor while you take a walk about the neighborhood. Leave them with friends while you run to the grocery store. Leave them with close family outside the household for a sleepover. Try out daycare for a day or two.

Willingness to Try New Things: Most children are curious to learn and explore. While they may (and hopefully do) demonstrate some caution in new situations, it’s typical for them to be willing to try something new. They will attempt new tasks knowing it’s ok to make mistakes. If you child refuses new experiences or even the thought of something cause fear or anxiety, this is a red flag they may need some extra help.

Transitions: They can generally transition between tasks quickly. Most preschools have a structure schedule throughout the day. Children are expected to transition between snack time, circle time, or play centers without much notice or verbal cuing. Similarly, when they have a usual routine, they should be able to anticipate what comes next. While is normal to show some disappointment when it’s time to leave their favorite task, they should be able to move fairly smoothly to the next task. If your child stay stuck on a task or demonstrates moderate upset, they may need some additional help.

Social Skills: Is interested in engaging with peers. Generally children want to make friends. Now, they may not always be great at it, but there should be a desire to connect with others. Look to see if your child will smile, wave, greet others, recognize other’s emotions, take turns, share, follow rules and limits, and cooperates when playing in a group.

Response to Problems: While a 3 year old is clearly not equip to solve problems like an adult, their response can tell you a lot about their emotional maturity. Do they show concern for friends. Will they attempt to use works when they're angry or frustrated or do they first act with physical aggression? Will they attempt to use please, thank you, and excuse me to help prevent problematic situations. Do they attempt to help friends when needed. Is their behavior is easily redirected.

Need help with any of these skills? Ask for an Occupational Therapy and Behavior Therapy Evaluation to improve your child's skills in this area.

Motor Development

Gross Motor: These are big body movements, usually move a child across space.

Enjoy outdoor play such as: running, jumping, climbing
Navigate a set of stairs with alternating pattern
Ride a tricycle
Bounce a ball
Kicks a ball
Throw and catch a ball
Hops 3-5x on each foot
Navigate around obstacles in environment

Fine Motor Skills: These are smaller more precise movements, usually done with the hands and fingers.

Puts together a simple puzzle
Makes continuous cuts with child-safe scissors
Cuts a piece of paper in half with scissors
Draws with a crayon, marker, or pencil

Hold using their fingers vs their whole fist

Copies a vertical and horizontal lines and circle
Traces around the edges of basic shapes
Interested in writing letters and numbers (although may not be able to form the correctly)
Stacking and building with blocks
Holds a book properly and turns pages
Begins to show if they prefer their right or left hand

Need help with any of these skills? Ask for an Occupational Therapy and Physical Therapy Evaluation to improve your child's skills in this area.

Independence Development

Dressing Self: And enjoys doing this!

Puts shoes on correct feet
Fastens large buttons
Attempts to smaller buttoning, zip their coat
Attempts to tie shoes
Putting on their own coat and other cold-weather gear

Brushes Own Teeth: May not be 100% accurate, but engages independently

Potty trained: Most preschools do expect children to be potty trained. Independence with toileting is a skill that has a great impact on self esteem. Now, it’s not uncommon for children this age to still need help with washing up or even may have an accident on occasion. However, this may not be a requirement at all pre-schools or if your child has extenuating circumstances.

Self feeding: Be able to feed themself a snack or smile meal. This may be a little messy but food should not everywhere. Attempts to use a napkin to wipe their face and clean up dropped food (even if they’re not accurate)

Independent Play Skills:

Play on their own without needing interaction or constant redirection from adults.
Find their way around the space/room.
Pick an activity from choices in a learning/play center.
Clean up their toys when asked
Uses realistic toys in pretend play or to imitate household routines
Engages in dramatic play with others to act out simple play scripts, such as playing house

Need help with any of these skills? Ask for an Occupational Therapy Evaluation to improve your child's skills in this area.

Language Development

Expressive Language:

Talk in complete sentences
Talk about everyday experiences
Begins to use descriptive language such as adjectives for color and size (“That’s a big dog with brown spots”)
Asks for help
Tells or retells a story

Receptive Language:

Responds to “wh-“ questions (who, what, where, when, why)
Understand expectations
Remembers short sequences of events of 2 to 3 steps
Follows simple 3-step related commands ( ie, get your coat off the hook, put it on and get in line)

Speech and Sound Production:

Uses most speech sounds correctly
Likes to imitate sounds and rhythm; might have a favorite song
Able to express themselves in a way that an unfamiliar adult can understand

Need help with any of these skills? Ask for a Speech Therapy Evaluation to improve your child's skills in this area.

Cognitive Development

Literacy Skills:

Recognizes first name when written
Recite the ABC’s
Able to name capital letters
Able to name lowercase letters
Knows letter sounds
Knows the main characters in familiar stories
Identifies rhyming words (ie, cat / hat)
Enjoys reading books with others

Math Skills:

Knows their colors
Identifies shapes
Able to count to 10
Identifies numbers 1-10
Recognizes and matches small quantities to the number words 1, 2 and 3
Shows interests in patterns and sequences
Match / sort / group /compare items

by color and shape
bigger, smaller,
heavier, lighter
over, under, above, below, through, front and back

Understands the order of the day, and begins to use some time words such as "morning" and “night"
Show an understanding of the passing of time

Science Skills:

Identifies all the parts of the body
Draw a picture of himself/herself that includes a head, body, arms and legs?
Identifies all 5 senses (sight, smell, taste, touch and hearing)
Asks many questions about how things work
Shows interests in tinkering with objects by taking things apart and putting them back together
Considers and offers explanations of how things might work
Develops object permanence and understands that objects continue to exist even when out of sight
Understands and explores empty containers and full containers

Need help with any of these skills? Ask for an Occupational Therapy, Behavior Therapy, and Speech Therapy Evaluation to improve your child's skills in this area.

Next Steps

If you've learned you child needs more help, you're in the right place. At TheraTree we believe in partnering with parents to best help your child. Sometimes parents come in with guilt that they didn't ask for help sooner or they were more persistent with getting a referral. We're committed that no parent should feel like they missed the bus on an opportunity to help their child. When parents come in for an evaluation or one of our free screenings, it's always perfecting time because you're getting the help right now in the present moment. If you have any concerns about your child's developmental don't hesitate to ask for help!

Call or Text 270-688-8449

Email: newpatients@theratreepeds.com

Or click the button below!

Get help now!

Understanding IEPs

Mon, 18 Apr 2022 19:26:35 -0500

by Rebecca Williams, RBT

Prior to becoming an RBT at TheraTree, I taught special education for four and a half years. I spent many hours over the last few years writing, reviewing, editing, and implementing IEPs (Individual Education Program), and communicating with parents and families regarding their child’s IEP. I reached out to several parents and asked them what they wished they had known when their child first started receiving special education services with an IEP. Based on their responses and my experience, I hope that I can help you better understand your child’s IEP and special education services.

The state of Kentucky has a common IEP template that is used across all school districts. This blog will walk you through each section of a standard Kentucky IEP and break down exactly what to expect in each section. This is the first in a series to help you to better understand your child’s special education services.

Plan & Student Information

Plan Information: IEPs are active for one calendar year. If an IEP is put in place on 4/26/2022, that is the meeting date/start date and 4/25/2023 will be the end date. Depending on the district, most annual meetings are scheduled at least two weeks before the end date of the current IEP.

Special education status indicates if students are actively receiving special education services, meaning that they have a current IEP in place. Special education setting is typically written as a percentage of the day in general education classes or may indicate special circumstances, such as home hospital.

The primary disability listed here is the disability determined by evaluation at the school. This may vary from other diagnoses/disabilities identified outside of the school setting.

Student Information: The student information is the information on file at your child’s school (name, birthday, address, grade, school, gender, race). If any of this information is incorrect at any time, make sure to let your school secretary know to update your child’s information on all school information.

Present Levels of Academic Achievement and Functional Performance

There are seven sub-sections in the present levels:

Communication status
Academic performance
Health, vision, hearing, and motor abilities
Social and emotional status
General intelligence
Functional vision/learning media assessment
Functional hearing, listening, and communication assessment.

Depending on your child, there may only be one or two of these sections completed, or there may be several. The most common sections are communication, academic, health, social/emotional, and general intelligence. For areas that are not a concern, there is a box that would be checked to indicate that there is no information needed for that area.

For the areas of concern, it should include baseline data (starting point for new goals), individual strengths and weaknesses in the area, comparison to same-age peers (using MAP scores, KPREP scores, and/or any recent evaluation data), and the adverse effect that the deficits in that area have on the child’s education.

In the academic performance section, all areas of concern should be addressed separately (reading, math, writing).

Each area that is determined to be an area of need must have a goal related to it (discussed later in the IEP).

Transition Services Needs

Post-secondary transition should become part of the IEP conversation starting in 8th grade or age 14, at the latest. Depending on the district, some may start this conversation once a child enters middle school. Similar to the previous section, there is an area for present levels for transition, including instruction, community experiences, daily living skills, and employment. This is the place that identifies student needs and strengths, as well as interests and future plans.

Postsecondary Goals: For each area identified as an area of need, there must be a post-secondary goal put in place. These goals are specific to individual plans after high school and indicate specific services available to meet these goals.

Course of Study: When transition becomes part of the discussion, a multi-year course of study must be completed, starting with the current school year and mapped out through graduation/completion of high school. This course of study is not set in stone, but is a starting point for planning courses that will assist in meeting the identified transition goals.

Transfer of Rights at Age of Majority: The final transition section is specifically for high school. This states that when a child turns 18, they will be able to make their own decisions regarding all special education services. The child and parent must be made aware of this at least one year before the 18th birthday, but some districts may choose to start this conversation during the child’s freshman year.

Consideration of Special Factors for IEP Development

This section looks at things such as behavior, limited English proficiency, visual impairments, communication needs, hearing impairments, and assistive technology. If any of these things are identified as something that impacts learning, most often, it will refer back to the present levels and/or provide a brief explanation of the needs. This is also where it is indicated if a child has a behavior intervention plan (BIP), which is a separate document.

Measurable Annual Goals and Benchmarks

All goals must be related to the information provided in the present levels.

Some districts require benchmarks or short-term objectives. This takes the goal and breaks it into smaller chunks to focus on one thing at a time. Once transition is a discussion in the IEP, the goals need to be connected to the post-secondary goals to assist in meeting those goals.

The goals must all meet the "SMART goal" criteria:

Specific
Measurable
Attainable
Realistic
Time based

The method of measurement indicates how the teacher plans to monitor the goals. This can be done in four general ways:

Curriculum-based measurement:

Oral reading fluency probe
Math computation probe
Math concepts
Applications probe

Direct measures:

Frequency count/event recording
Duration recording
ABC recording – antecedent, behavior, consequence
Checklist

Indirect measures:

Rubric
Checklist
Employer/employment specialist interview
Teacher-made tests
Student self-monitoring

Authentic assessment:

Student interview/conference
Portfolio
Work samples

The last part of this section is specially designed instruction. This is defined as what the teacher does to ensure progress is being made on the goals. This can include modeling, role-playing, pre-teaching vocabulary, and implementing various strategies. This is just a basic outline. There is more to come to further explain IEP goals and progress monitoring.

Reporting Progress

This section indicates when progress reports will be sent home, discussing your child’s progress towards their annual goals. Typically, this is sent home the same time as report cards throughout the year.

Supplements & Accommodations

Supplementary Aids and Services: Supplementary aids and services are what the student needs. This can include identified accommodations, as well as visuals, prompts, preferential seating, and any modifications to tests and assignments.

Accommodations for Administration of State Assessments and Assessments in the Classroom: The goal with accommodations is to promote independence and eventually fade accommodations, as appropriate.

Accommodations include:

Reader
Scribe
Paraphrasing
Calculator
Use of technology
Manipulatives
Reinforcement and behavior modification strategies
Braille
Interpreters
Extended time.

Modifications include:

Shortening an assignment
Extending a deadline
Changing different parts of an assignment.

Alternate Assessment

Includes: Kentucky Alternate Assessment Participation Guidelines Documentation Form & Learner Characteristics Inventory. This section is only applicable to individuals with the most significant disabilities. I will be going in depth on alternate assessment soon, as it is too much to provide a brief overview.

Program Modifications

Includes: Program Modifications & Supports for School Personnel that will be Provided. This section discusses anything that may be needed by adults to appropriately implement the child’s IEP. This can include modifying adult schedules to address toileting, feeding, or transition needs. It can also include any specialized training, such as Safe Crisis Management, that may be needed for anyone who works with the student. This section also includes consultation and/or collaboration with related service providers, general education teachers, other special education teachers, bus drivers and monitors, paraprofessionals, and any other relevant adults.

Least Restrictive Environment

Includes: Least Restrictive Environment (LRE) and General Education.

This section discusses how often a child will and will not be in the general education setting. Students with disabilities are required to be in the general education setting as much as possible.

This can look like a general education setting, a co-teach general education setting, a resource setting, or any mix of the above, depending on individual needs. The LRE also includes special circumstances, such as home hospital and institutions.

Special Education & Related Services

For special education services, each subject must be listed separately. The service minutes can vary based on setting (resource vs. general education) and level of need.

Special Education Services include:

Reading/writing/language arts/English
Math
Science
Social studies
Daily living skills
Social skills
Pre-employment/transition skills.

Related Services include:

Speech, Language, and Audiology Therapy
Physical therapy
Occupational therapy
Special transportation: wheelchair lifts, additional supervision/bus monitors
Counseling Services: provided by qualified social workers, psychologists, guidance counselors, or other qualified personnel.
Interpreting services: for children who are deaf, hard of hearing, or deaf-blind
Orientation and mobility services: for blind or visually impaired children
Medical services: Usually for medicine not administered orally
May also include services for children who are 100% dependent for bowel/bladder maintenance and feeding.

Related services can all vary in frequency and duration, as well. It is notable that to qualify for these related services, the student's education must be impacted and require that specific skilled service to improve education. It is not the same as qualifying for outpatient therapy. In the outpatient and other settings, the goals and course treatment must and will be different than the service provided through the school system.

Extended School Year

This is not super common, but must be addressed at all annual IEP meetings. Extended school year is implemented if a child fails to make sufficient progress, or significantly regresses over school breaks, without the ability to recoup information once back in school. There must be data to support the decision and the services must occur outside of a regular school day, week, or year.

Summary

This blog has been an IEP in a nutshell. More in-depth information regarding IEPs and special education services to follow.

For more information, visit Kentucky Parent and Family Special Education Resources: https://education.ky.gov/specialed/excep/Pages/FamParRes.aspx

Resources used:

https://education.ky.gov/specialed/excep/forms/Documents/KYIEP10.26.18.pdf

https://education.ky.gov/specialed/excep/forms/Documents/IEP_Guidance_Document.pdf

The 4 Functions of Behavior

Thu, 13 Jan 2022 11:34:00 -0600

by Lauren Haire, RBT

Imagine this: You are grocery shopping and, in the aisle, next to you, you hear a child arguing with their parents. They won’t stay seated, and they are yelling. It is very common to watch a child “act out” in public with their parents. You sometimes think, “can they just tell them to stop and be quiet?” It is not always as simple as that.

As a parent and professional that works with children, it’s important for you to understand the 4 functions that drive behaviors that you see in children. Children with Autism can often struggle to communicate and engage in problem behavior to get their point across.

ABC's of Behavior

Behavior can be broken down into 3 parts to determine the function:

The antecedent is what happened prior to the behavior of concern.
The behavior is the behavior of concern.
The consequence is what happened after the behavior was demonstrated.

Example: Lauren saw the toy on the counter and began to cry. Her mom gives her the toy.

The antecedent is that Lauren saw the toy, the behavior is when she began to cry, and the consequence was her mom giving her the toy. The function here is that Lauren was looking for access to a tangible (to get something.) Her mom gave her the toy which extinguished her crying behavior.

4 Functions: SEAT

A child's behavior is always functional - they're behaving a certain way for a reason. There are four main functions/reasons for a child's behavior. The easiest way to remember the functions of behavior is with this simple acronym. SEAT. Sensory, Escape, Attention, and Tangibles.

Sensory

The sensory function provides stimulation from the world to the brain. Sensory information can be in the form of touch, sound, visual, smell, taste, movement, or pressure.

When does it happen? Children seek out this sensory information because their body can’t get enough of it to use functionally OR they’re overriding a different sensation. In many children with Autism, this shows up as stimming. It can occur at any time, especially when anxious or excited.

How can I help? Redirect to more appropriate behavior that offers similar sensation. If you notice any behaviors that indicate a sensory deficit, you may benefit from receiving a free screening from one of our occupational therapists to address sensory needs. Occupational Therapy can address deficits related to sensory modulation (I.e. sensory over responsiveness or under responsiveness), sensory discrimination(i.e. attention), and sensory based motor(i.e. motor planning, balance, and postural adjustments.)

Example, a child may exhibit signs of overexcitement. You can relieve that need to release energy by allowing the child to go for a walk or riding a bike.

Escape

The function of escape removes undesired activities, interactions, or situations. The child is getting out or away from the situation, environment, or task.

When does it happen? It can occur when the tasks are understimulating, too easy, too hard, boring, or just completely undesired.

How can I help? Provide a “first, then” prompt, offer choices, or alter the length of task.

Example: “First clean up, then you may go watch tv.”

Attention

The function of attention provides access or awareness to/from people or interactions. It’s important to consider what kinds of attention the child likes and how much and when they’re currently getting attention.

When does it happen? It occurs when social attention is desired.

How can I help? You can provide positive reinforcement or attention before the behavior occurs, so they don’t “need” to do the problematic behavior.

Example: “Great job picking up. I like that you are following my directions.”

This statement gives positive reinforcement for picking up and following directions while feeding the potential attention seeking behavior. If we reinforce the negative attention seeking behavior, we could risk making the behavior worse. So, it’s important to reinforce only the positive things your child is doing during a difficult situation.

Tangibles

The function of access to tangibles provides preferred activities/items. This is what we usually think of as a “reward”. Although rewards don’t always need to be tangible to be considered reinforcing. We can use tangible rewards to help each then fade them.

When does it happen? It occurs when there is a preferred activity or item desired.

How can I help? There are several different ways you can approach this.

- You may teach the child to verbalize their wants and needs.

- If your child is nonverbal, teach sign language, use pictures to communicate (ABA uses Picture Exchange Communication), or assistive device like an iPad.

- Contrive teaching situations at home and this goes along with teaching the child to verbalize wants and needs.

For instance, let’s say your child loves to listen to songs on their iPad/tablet. As you listen to the song, try to pause and play the song. When the song is paused, verbally prompt the child to say ‘Play it.’ Praise the child heavily: ‘Great saying play it.’ And then immediately play the song. Again, this is just an example of how to use a highly preferred item as a teaching moment.

You can prompt your child to request based on their needs and level of language skills, then gradually fade the prompt. Remember, reinforcement increases the occurrence of behavior whether it is positive or negative.

We're Here to Help!

Don’t forget that “SEAT” is your go-to acronym when deciphering your child’s function of behavior. By contriving teaching situations in the natural environment, you can help your child practice communication skills, social skills, and give them the ability to communicate their sensory needs. Take ABC Data to keep track of behavior and present data to your pediatrician and/or your Board Certified Behavior Analyst (BCBA.) Your child may benefit from ABA Therapy or Occupational Therapy to assist in these behaviors!

Behavior can be complex! That’s why professionals have specialized in this science and are devoted to educate and help. If your child engages in challenging behaviors, you don’t have to figure it all out on your own!

We want to help. Call or text us at 270-688-8449 or email newpatients@theratreepeds.com to schedule a free screening or comprehensive evaluation. Let’s decrease your overwhelm and increase your relationship with your child together!

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New Year's Resolutions and How to Actually Achieve Them

Fri, 03 Dec 2021 14:42:20 -0600

The most common resolutions people typically make are to lose weight, to save money, to learn a something new, to become more organized, to stop smoking/drinking, and to become overall healthier (eating homecooked meals versus fast food, buying a gym membership, going to bed earlier, finding a new, less stressful job, etc.). One on-line poll in 2020 showed that by about 68% of people give up on their goals after approximately 32 days. The most common reason: lack of discipline. Other factors for abandoning these resolutions included busy schedules, not having “enough time,” and even peer pressure. So the question is: How does one make a New Year’s Resolution and actually follow through with it? Generic answer: Hard work and commitment.

Don't Think it - ink it!

Every New Year’s Resolution that a person makes is an attempt to fulfill something within their basic needs; To satisfy quality world pictures. Something to make their lives a little bit better. No one ever makes a resolution to make things worse. However, having another commitment to fulfill is often times very stressful and ultimately discarded because one already has “too many irons in the fire.” But these Resolutions should be viewed as a form of self-care and most people tend to put taking care of themselves at the bottom of that list. As this list continues to grow with other obligations, eventually, the resolutions are taken off the list. In order for these resolutions to be achieved, resolutions must become a priority! (Using concepts of Dr. William Glasser’s Reality Therapy and Dr. Robert Wubbolding’s WDEP system, this is where I tell you how!)

By Jacob L. Wright, M.Ed., LPCC-S, NCC

Reviewed and Edited by Michael Fulkerson, LPCC-S and author of Treatment Planning from a Choice Theory Perspective

Well, it’s that time of year again. The Time of year people start thinking about those promises to themselves that they’re not really going to keep. Every year, many people create a New Year’s Resolution with good intentions of keeping them, but soon throw them out along with all the boxes and wrappings of the holidays. In the beginning, these people are very determined and motivated to make changes in their lives. Why? By the end of the year, most people are stressed and overwhelmed and tired of being stuck in a rut. Tired of being broke. Tired of being stressed. Tired of being fat. Tired of being… tired. I know this all too well. I have been one of those people!

Take a few minutes to think about what your resolution would be for the new year. What is something that you feel would improve your outlook on your life? Or improve the quality of your life? Write it down. Don’t’ just think it, INK IT! Chances are, this is something you’ve wanted for a long time. It may also be a resolution you’ve tried to achieve before and didn’t follow through with. Now think about the impact this would have if you were to achieve this. Can you describe it? How would you feel if you could make this happen? Now ask yourself how badly do you want it? Do you just kind of want it? Or do you really want it? There is a big difference in your motivation depending on how you answer this question!

Overcome Past Efforts

Once you know what you want and how badly you want it, think about what you’ve tried in the past to achieve this goal. Write it down! If this is a brand-new want, you may not have tried anything before. And that’s ok! If this is something you’ve wanted before, and did not follow through with, that is okay, too! If this is something you’ve wanted for a long time and have tried many things, how well did it work out? What are some of the things that did work and what are the efforts that did not? Again, write this down.

By now, you know what you want and how badly you want it. You are also aware of your past efforts, what has worked and what did not. Now ask yourself “What can I do differently and what am I willing to do to make sure this works this time.” This is your plan of action. Be as detailed as possible. If your resolution is to lose weight, write down how you’re going to do this. Example:

I will commit to exercise 3 days a week for 1 hour (Monday, Wednesday and Friday)

I will cut down to only having fast food 1 day per week and eat home cooked meals the rest of the week

I will drink 72 oz water per day. (Break this down into how many ounces per hour.)

I will cut down on sodas to 1 per week and replace with water or unsweet tea.

Dr. Robert Wubbolding, author of Reality Therapy for the 21^st Century, attests that for a plan to be effective, it must be “Simple, Attainable, Measurable, Immediate and Controlled by the planner (SAMIC).”

It can be whatever steps you feel you need to take to make this happen. If you find yourself not knowing what steps need to be taken, make a step to include researching or talking to someone who knows more about what it is that you want. Again, be specific and realistic. Don’t set standards too high. Committing to working out 3 hours a day 7 days a week can be overwhelming and set someone up to fail. If you can do more on certain days than usual, do it. But only write down what is manageable and what you’re willing to commit to.

Commitment

If you’ve gone this far, why not go ahead and sign it. Put your signature and date somewhere on this as a written contract to yourself. Now take it a step further and post it somewhere where you will see it every day, or maybe several times a day. Put it on the fridge if you have to. This can help you hold yourself accountable for your goals.

My personal recommendation is to document your progress once a month until you’ve reached your goal. Review your contract. Are you still reaching for the same goal? What have you been doing to make this happen? Is it working? Why or why not? And if it’s not working as well as you’d like, are there modifications to make to your plan? If so, write it down. Sign it. Date it. And keep going!! If you say you can, or say you can’t, you’re right!! You are in control! You are the only one that can make this happen for yourself. You’re worth it!! If you want it, go for it! You got this!!

Cheers!

Want more support to life your best life? We offer counseling for both children and parents! Not sure if counseling is right for you? Do a free screening to see if it's the right fit!

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5 Signs Your Child May Benefit from ABA Therapy

Tue, 09 Nov 2021 17:41:52 -0600

5 Signs Your Child May Benefit from ABA Therapy

By Lauren Haire, RBT

Applied Behavioral Analysis (ABA) is a therapy based on the science of understanding and improving learning and behavior. It helps us to understand how behavior works, how behavior is affected by the environment, and how learning takes place.

Below are some of the signs that your child may benefit from ABA Therapy:

Autism Spectrum Disorder

If your child has been diagnosed with Autism, we are here to help your child acquire skills or decrease those behaviors of concern. ABA Therapy can break down skills to smaller, discrete tasks to help a child learn.

Delay of Social Skills

Through ABA Therapy, your child will be able to increase their social skills and build meaningful relationships. If your child has difficulties making eye contact, taking turns with peers, or identifying their coping strategies, it could be a sign they could benefit from receiving ABA services to help increase those skills.

Delay of Receptive/Expressive Language

If your child has difficulties with “out of the box” thinking, ABA Therapy can be used to spark creativity. It can help a child to follow those simple to multi step instructions, comprehend who/what/where/why questions based on stories or pictures, or even increase imitation skills.

Delay of Communication/Speech

You may have noticed that your child is delayed in their communication skills. ABA can help increase their ability to express their wants and needs. While using motivating operations and positive reinforcement, ABA will teach the child to mand, or request, as well as engage in conversation.

Problem Behavior

The four functions of behavior include sensory, escape, attention, and tangibles. These functions help Behavior Analysts to create a proper treatment plan based on the behavior function presented. While there are many examples of problem behavior, if your child exhibits tantrums, self-injury, non-compliance, or eating nonedible items, ABA may be able to decrease these behaviors by using replacement behavior that can serve as the same function.

Difficulties and Diagnoses ABA Therapy Can Help With Include:

Aggression
Self Injury
Noncompliance
Tantrums and Outbursts
Decreased attention
Poor social skills
Poor Memory
Challenges with academics
Depression
Autism Spectrum Disorder (ASD)
Attention Deficit Hyperactivity Disorder (ADHD)
Obsessive-compulsive disorder (OCD)
Fears and phobias
Anxiety
Traumatic brain injury

Techniques Used in ABA Therapy:

Positive Reinforcement
Prompts
Task Analysis
Generalization
Picture Exchange Communication
Errorless Teaching
Social Skills Training
Discrete Trial Training (DTT)
Natural Environment Training (NET)

If you have any questions or concerns about your child, please reach out to us at TheraTree. We provide free screenings! You can reach us by phone/text at 270-688-8449 or email at newpatients@theratreepeds.com.

Together we grow minds, bodies, and spirits!

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Children's Mental Health: Experiencing a Life They Love

Tue, 19 Oct 2021 23:09:17 -0500

Mental Health Therapy is not the easiest for parents to discuss. Mental health continues to be an area most are hesitant to ask for help with. Nobody wants their child to “need therapy”. Whether a child has a history of trauma or is simply struggling with being human, we can help.

It makes sense that parents and guardians need and benefit from professional insight. This is especially true for sensitive subjects or developmentally appropriate issues of growing up. Growing up is hard work! Many assume therapy is only reserved for big problems like abuse, neglect, and trauma. However, therapy can be focused on positive growth, strengths, and experiencing a life they love without one specific life event causing the interruption.

Almost 4 million children and youth experience mental health challenges. Mental, emotional, and behavioral disorders in childhood can cause long-term problems affecting development, health, education and well-being. If left untreated, these delays may persist and greatly effect adulthood. A 2009 study found only half of children and youth with anxiety, disordered eating, depression, and ADHD received care. That's why we've added this way to help.

When to Get Help

Many times these “glitches” in a child's life may not be glaringly obvious to the people closest to the child. The good news is you can play an important part in your child’s mental health by being observant and seeking a professional evaluation to determine if help is needed. Children and youth need mental health therapy when they have mental, emotional, or behavioral challenges that they are not effectively cope with alone. This means their challenges are affecting how well they do, feel, or act.

We get that as a parent, you want nothing but health and happiness for your child. When your child is distressed, that can be hard to cope with as a parent. Particularly when you feel like nothing is working or there’s nothing you can do to “fix” it. Sometimes you simply can’t “fix” it on your own – especially when you are emotionally invested in the situation yourself. That’s when it’s best to ask for professional help.

Red Flags

It is important to understand that children who are experiencing distress, may not directly share it with their parents. That doesn’t mean your child doesn’t love or trust you. The truth is many children are unable to fully process and explain the complexities that accompany the emotional and/or psychological challenges they are experiencing. Sometimes children even withhold communication in fear of disappointing their loved ones. Therefore, caregiver observation is key to getting help.

Treating mental health challenges as soon as possible can help children reduce problems at home, school, and healthy development into adulthood. It truly sets them up to experience a life they love.

Behavioral Signs

Unprovoked aggression
Unusual, unexpected, or sudden changes in behavior
Distressed easily and quickly over little things
Low grades or a sudden academic decline
Refusal/strong resistance to attend school
Repetitively performing rituals and routines like hand-washing
Your child responds to voices he/she hears in his/her head
Alcohol / drug use, abuse, or addiction
Excessive neglect of personal appearance or hygiene
Dangerous or illegal thrill-seeking behavior
Paranoia and excessive secrecy
Excessive perfectionism
Excessive avoidance to protect self

Emotional Signs

Worry, anxiety, or fear
Anticipating worries well in advance
Feeling down, or sad more often than not
Suicidal ideations (thoughts) or attempts
Not feeling worthy, or “good enough”
Having “rollercoaster” moods
Feelings of hopelessness

Cognitive Signs

Difficulty concentrating on important tasks
Problems with memory
Intrusive, obsessive, or racing thoughts
Unable to communicate feelings; shutting down
Delusions or hallucinations

Social Signs

Difficulty adjusting to social situations and/or new situations
Social withdraw from activities your child once liked or loved to do
Marked decrease in enjoyment and time spent with friends and family
Spending most of his/her time alone or engaging in voluntary social isolation
Trouble starting and maintaining relationships
Overly suspicious of others
Constant Need for Reassurance

Physiological Signs

Too much/little sleep, nightmares, bed wetting
Changes in eating patterns, too much/little, weight loss/gain
Changes in their energy levels, energetic vs fatigued
Stomach aches, nausea, headaches, backaches without a medical explanation (constantly going to the nurse - but a legitimate need for medical care is ruled out)

Environmental Factors

Grief and the death of a loved one, pet, home, etc.

Bullying
Sexual, emotional, and/or physical abuse
Witnessed abuse and/or intimidation
Relocation issues (i.e. changing schools, homes, families, and/or cities/states)
Family substance abuse or addiction

Keep in mind that children of all ages and abilities, from toddlers to teens and verbal to non-verbal, can benefit from mental health therapy.

Who Can Help?

Mental health Therapists include: Licensed Professional Counselors, Licensed Clinical Social Workers, and Licensed Marriage and Family Therapists. These professionals offer invaluable insight into your child’s social and emotional development and mental health. Mental health specialists have the knowledge and expertise to recognize, identify root cause, assess, diagnose, and treat a wide range of mental health conditions, adjustment issues (divorce, new school, bullying, grief, etc.), and psychological distress.

Their purpose is to help children better interpret what they are dealing with and/or the trauma that occurred – in a way they can process and understand. This helps children work through their emotions and experiences so that they can live life without the lasting effects of fear, confusion, anxiety, or trauma. Ultimately, Mental Health Therapists help your child to resolve his/her challenges and resume a healthy and productive life.

How Therapy Works

Children learn by doing and therapy is no different. While therapy greatly differs based on the age of the child, most therapy sessions work through problem-solving skills and talking about feelings. With younger children, this looks like working with the whole family, drawing, playing, and talking. For older youth, they work through sharing and directly learning to develop the skills needed to work through problems. Therapy looks different for each patient; there is no one-size-fits-all treatment. Therapy is designed to identify the root cause of the child’s challenge. Then, the therapist can work with the child/family to develop skills to cope, problem-solve, and create healthy thinking patterns.

Therapy will usually be future-oriented. Meaning there will be little looking back or digging up the past. Instead, they will be working towards an optimistic future, developing positive coping methods, as well as boosting self-esteem, self-confidence, and other positive states and traits. Therapists give praise and support as children learn. They help children and youth believe in themselves and find their strengths. Therapy builds helpful thinking patterns and healthy behavioral habits. Therapy can provide them with opportunities to not just survive after trauma but thrive in life.

A therapist might meet with the child and parent together or meet with the child alone. It depends on the child's age and their specific situation. When children are young, it is common for therapy to include the parent. Parent-focused approaches typically mean that parents talk with the therapist about the child’s behavior and feelings then the parent implements with their child at home. Regardless of the age or structure established, therapists do want to meet with the parent/caregiver within the appointment to give tips and ideas for how to help their child at home. Therapists may also observe parents and children together and then make suggestions for finding different ways to react. Sometimes, entire families need support while trying to communicate, learn, and create boundaries. Sometimes other important adults in the child’s life (for example, a teacher) are included as well.

Parents are usually concerned with how long treatment will take and how soon they will see progress. How quickly your child makes progress will depend on the complexity of his challenges, how long the problem has had to take root, and the established goals of therapy. Being aware of the factors that affect results can help you form realistic expectations and avoid frustration. For example, a child who is severely anxious may have difficulty participating in therapy. A teenager with depression may resist treatment, and need help to see how they might benefit from it. Missed appointments and conflicts between parents over the need for therapy can also undermine and limit progress. One overwhelmingly positive influence is having a supportive and involved family and regularly kept appointments.

What's Next...

If you have any questions or concerns about your child please reach out to us at TheraTree. We provide free screenings and full mental health evaluations. You can reach us by phone/text at 270-688-8449 or email at newpatients@theratreepeds.com.

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Anxiety in Children

Wed, 21 Jul 2021 17:32:20 -0500

By Jessica Hatfield, Ms, OTR/L

Children are constantly learning, growing, and adapting to their environment. Even when we give the most stable and routine environment, things still always and inevitably change. Change is normal and children seek to feel safe and secure.

It is important to note that some worry and stress is normal and even needed for survival. The primary purpose of our ‘fight or flight’ response is to keep us safe. Stress and worry are also useful to our growth because we are challenged to try different things. We want our children to grow and adapt for the ever changing pace of life.

However, some children consistently demonstrate difficulty adapting because of a perception of danger surrounding a task. Particularly if there is uncertainty or there has been a previously negative association. At time several less intense events can build up to cause an overwhelm. Both of these negatively affect their daily living. Pediatric anxiety has grown to be one of the major mental health issues facing children. Anxiety is experienced in the pediatric population at increasing rates. 7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety. (Ghandour 2018)

What is Anxiety?

Anxiety is apprehension about the future. Behaviors will also begin to affect thinking processes. For example an expectation is unrealistic and in turn leads to ruminating or negative thoughts. Anxiety can cause negative mood and physical tension. There are many different types of anxiety including separation anxiety, OCD, perfectionism, social phobias, or generalized anxiety etc. Anxiety is different than fear and panic, although a person can experience these as well. Fear is an immediate alarm to current danger, physical arousal, and avoidance. Panic is fear at an inappropriate time. It’s abrupt, intense, and physically arousing.

What Causes Anxiety?

A variety factors can contribute to anxiety in children. Children may observe and replicate anxious behaviors of others. Life experiences may also trigger anxious feelings and behaviors. For example loss, serious illness, bullying, or other types of abuse. Genetic factors that effect brain chemistry can cause a child to be more predisposed to developing anxiety.

What Causes Anxiety?

Agitation, jittery, or restlessness

Sleep Deprivation or nightmares
Easily upset or crying on a regular basis
Panic Attacks, heart pounding, palms sweaty, trouble breathing
Somatic symptoms of physical pains, e.g. headaches, tummy aches, nausea
Repeated behaviors or phrases that are familiar
Tantrums, including meltdowns before school about inconsequential issues like socks
Clingy to the point it is disruptive
Constantly seeking the reassurance from others
Tries to get others, particularly adults, to do things for them
Asks for assistance for tasks they can complete independently

Children may say phrases like:

Something terrible will happen.
I don’t have any control over it.
It will be my fault if it happens.
I don’t know what to do!
I have to get out of here!
I need to know for sure that it’s okay
I can’t make any mistakes

Always on the lookout for danger and checking to make sure things are safe.
Dislike or avoidance of new or difficult tasks
Avoidance behaviors or trying to stay home from school
High expectations of self
Low self-esteem and confidence
Delayed social skill development and difficulty maintaining relationships
Decreased motivation for certain tasks

Child might demonstrate a few of these behaviors occasionally and some of these signs may be cause by other factors not related to anxiety. However when negative, anxious behaviors become more common or intense, your child may qualify for an anxiety diagnosis. When experiences these frequently or at extremes, the natural protective responses triggered no longer serve as protective and become debilitating. High levels of anxiety can make it difficult for a child to participate everyday activities including school, play and friendships. When anxiety interferes with your child’s ability to play and learn, it’s time to talk to a professional.

What Causes Anxiety?

For children experiencing anxiety, it is a natural response for parents to want to step in and solve the problem. However this is not the best long term strategy to actually help your child with their anxiety. By removing or allowing your child to avoid, you are unintentionally reinforcing their anxieties and removing opportunities to develop coping skills and resilience. Therefore it is important to give your child the opportunity to work through their fears in order to develop these highly important skills. This is best done by working with professionals. There are several profession who help with anxiety:

Occupational Therapists to apply concrete strategies.

Psychiatrists and nurse practitioners to prescribe medication.

Psychologists, social workers, and counselors to provide emotional support.

How Occupational Therapy Helps

Occupational Therapy (OT) can be thought of as the therapy of taking action! There are many ways we can talk to our children about their worries and fears, but by teaching them concrete strategies we empower children to become independent in their own lives! Occupational therapy providers step in to bridge the gap so children can learn to function and feel how powerful they really are when it comes to their thoughts and abilities. Occupational Therapy intervention addresses anxiety through the followings ways:

Proactive strategies

The purpose of proactive strategies is to prevent the anxiety from occurring. This provides a short term benefit but is not helpful long term as our environment is always changing and adaptability is a survival skill. Some proactive strategies include establishing routines, visual schedules, and adapting the environment (ex sensory-friendly environments, fidget toys, quiet corners etc).

Teaching, Thinking, and Applying Strategies

The purpose of these strategies are to increase both interoception and communication strategies so children can manage themselves to identify and prevent anxiety. These provide the most long term benefits in their life. These strategies include interoception, effective education, cognitive restructuring, and communication to adults about what they are experiencing and their wants/needs.

Reactive Strategies

The purpose of reactive strategies is to help in the moment while a child is experiencing anxiety. This has both short and long term benefits. However the difficulty with teaching reactive strategies is bridging the concept of “what to do” with actually being able to recall and apply them in the moment. Generally these skills take longer to develop because of this. These strategies include Guided Imagery, deep breathing, distraction, quiet time, calm/comfort techniques

Parenting Strategies

As with all Occupational Therapy intervention, parent education is important. Parents have a big influence on how their child with learn and respond by the tone they set. Occupational Therapy Providers teach parents how to be both proactive and reactive with their child. They teach what not to do. Often parents need to utilize calming strategies of their own when interacting with their child who is in a heightened state of arousal. When children are in a heightened state, they may have difficulty understanding complex language. So simplifying the words spoken to them can have a big impact on their reaction. Occupational Therapy Providers also teach parents by example and self reliance.

What's Next?

If you have any questions or concerns about your child please reach out to an occupational therapist at TheraTree. You can reach us by phone at 270-688-8449 or email at newpatients@theratreepeds.com.

Get Started Now

References:

Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ. Prevalence and treatment of depression, anxiety, and conduct problems in U.S. children. The Journal of Pediatrics, 2018. Published online before print October 12, 2018

Gobrial, E., & Raghavan, R. (2017). Calm child programme: Parental programme for anxiety in children and young people with autism spectrum disorder and intellectual disabilities. Journal of Intellectual Disabilities, 1744629517704536.

2-Wheel Bike Riding

Wed, 30 Jun 2021 15:10:48 -0500

By Kaitlin Alvey, MS, OTRL

The sun is shining, the wind is blowing, and it is a beautiful day for bike riding. Have you ever wondered how children learn to bike ride? Have you ever tried bike riding and everytime it ended in tears? You may not know where to start with teaching bike riding and that is okay.

Bike riding is a big skill that we expect children to learn between the ages of four and eight years old. When I say that age it is all based on development. If your child is developmentally behind, you can expect that bike riding may take longer to learn and/or happen at a later age. I wanted to provide you all with some information about the skills needed for bike riding along with some tips in progressing with bike riding.

Skills Needed for Bike Riding

So let’s start with the skills. Below is a breakdown of some of the things required to bike ride:

Leg Strength: Pedaling and pushing a bike requires strength to push in a downward motion to move it forward.

Balance: It takes a lot of coordination to balance on the seat and maintain position while it is moving.

Core strength: Core muscles are vital to our participation in many movement activities and especially bike riding.

Bilateral coordination: This means that the child has to use both sides of their body at the same time. Bike riding requires this skill in being able to hold both handle bars and coordinate both legs to propel.

Visual motor skills: Some people also refer to these skills as hand-eye coordination. If you think about bike riding, we have to be able to look with our eyes and tell our body what to do. This helps a child decide whether they are going to keep going or stop or move side to side to avoid an obstacle.

Steps & Tips for Bike Riding

So now that we have the skills, let’s talk a little bit about some recommendations for progression. Often times, I do not recommend children starting with training wheels on their 2 wheeled bike. Especially with children who are developmentally delayed or having difficulty in any of the above skills, they may use the training wheels as a crutch for their skills. This is not true for every child, so it is something to consider for what fits best for your child.

STEP 1: Modify the Bike

PEDALS: When a child first gets a two wheel bike, I recommend removing the pedals. Removing the pedals?? Yes! When you remove the pedals, it allows your child to get used to balancing on the seat and propelling the bike forward. If you have ever seen a balance bike, this is the same concept without having to get another bike. Without the pedals, a child can work on coordinating where to put their hands, pushing with their feet, and looking at where they are going. Make sure you child can first try in a straight path and then can work on steering a little later.

SEAT: When you remove the pedals, the next step is to lower the seat. You want the seat to be low enough so that they can propel through pushing with the ball of their foot.

Tip: You do not want your child to be able to push all the way through their heel because they may rely on that more for balance than using their core muscles.

STEP 2: Add One Pedal

So your child has mastered balancing and riding the bike without pedals. They can steer, propel it forward, and can feel the wind across their face! Next it is time to add on one pedal. You can choose which ever side would work best for your child. If they are five years or older and have hand dominance, I would recommend putting the pedal on their preferred side first. So this may seem kind of silly and that is okay! Putting one pedal on allows your child to master the motor movement on one side rather than having to coordinate both sides together. They can also still use their other leg to help catch them from falling. Once they have mastered pedaling with one side, take that pedal off and put the one on the other side. Repeat the process until they are able to coordinate and propel the bike forward.

Tip: You do not want to switch your child’s pedal until they have mastered it on the one side. The length of time to master this skill varies for each child and is discovered by them practicing on the bike.

STEP 3: Add The Second Pedal

It is time for two pedals!! At this point your child has learned all of the small skills required for pedaling with two pedals. When you place the two pedals on, they will learn the new balance of having two legs off the ground and watch them go!

Bike riding is one of my favorite summer time activities and I hope that this has helped to provide a way to support your child in bike riding this year! If you have any questions or concerns about your child and development please reach out to an occupational therapist at TheraTree. You can reach us by phone at 270-688-8449 or email at contact@theratreepeds.com.