Medical Resources for Families

 Did you know we have a Family Resources tab on our website? This is our go-to place for providing information to families and districts regarding helpful resources that can be accessed online or even locally in the Dayton Miami Valley region. 

When you click on the tab, there are several sections including:

• Online Resources (topics include: New Autism Diagnosis, Puberty & Sex Ed, Girls on the Spectrum, Wandering & Elopement, and Healthcare)
• Local Resources (topics include: Local Support Groups, Mental Health & Behavioral Support, Wrap Around Services & Case Management, Medical Support, County Boards of Developmental Disabilities, Recreation Programs, Social Skills Groups, and Childcare/Respite Care)
• Websites
• Online Courses

Today we are going to highlight some of the resources included in our Family Resources Tab for Local Medical Resources: 

Mental Health & Behavioral Support

• Ohio's Telepsychiatry Project for Intellectual Disability
• Montgomery County DDS Behavior Support Services
• Dayton Children's Mental Health Resource Connection
• Guide for New Mental Health Caregivers
• I am Boundless, Inc.
• South Community Positive Health Solutions (wrap around serviced available)
• Diana Holderman, M.Ed., LPC, TRCC (937)-694-0967 diana@stratsforbrhaviormgt.com
• consulting and counseling multifaceted behavior support services for children, licensed PLAY Project and Teaching PLAY Consultant

Wrap Around Services/Case Management

• Ohio RISE: a specialized managed care program for youth with complex behavioral health and multisystem needs.
• Ohio Minds Matter
• CME Referral Link (Darke, Clark, Greene, Miami): https://form.jotform.com/221865738579171
• CME Referral Link (Preble, Montgomery): https://form.jotform.com/222503651849054
• Clark County Family Stability
• Greene County Family Stability

Medical Support

• Partners for Kids
• Family Resource Connection
• Goodwill Easterseals Miami Valley
• Medical Equipment Loan Program

Do you know of other great local resources to share with families in the Dayton Miami Valley region? Contact Allison Officer at allison.officer@mcesc.org and we will add it to our tab! 

Communication Corner: Why PECS Still Works

Do people still use the Picture Exchange Communication System (PECS)? This was once a popular evidence-based communication intervention but it seems to be a thing of the past. But don’t throw away your PECS manual! There may be a student who still needs this approach. In this post, our Speech and Language Pathologist, Carol Dittoe, will give her feedback on the use of PECS.

As the speech pathologist on the Autism and Low Incidence Coaching Team (ACT), Isometimes asked about my thoughts on the use of PECS.  I want to be clear that PECS is a specific and trademarked system that follows a very detailed protocol that requires training from a Pyramid Educational Consultant. I have been through the formal training but I have also adapted it when needed (so I can no longer officially call it PECS). For more information visit the official PECS website  In today's Communication Corner, I will provide my thoughts about the use of PECS which are based on many years of experience and observations.

• PECS is more than just using Pictures. PECS is the use of picture EXCHANGE. The E in PECS means exchange. Sometimes when you start with an AAC device, especially a dynamic device, the student focuses on the technology only and does not acknowledge the communication partner.  If the learner is able to see and manipulate a picture, they can develop joint attention by exchanging the picture with a partner to gain the desired item. If they love technology, use picture exchange to request the iPad. 

• PECS is not always my first option for Augmentative and Alternative Communication (AAC). It is not a prerequisite of AAC. It depends on the needs of the learner. If the learner has good joint attention and is already showing some use of pictures to communicate, I will move on to an AAC device or a static picture-supported communication system that is much more robust.  If the learner does not demonstrate joint attention and does not engage with pictures for communication, PECS is a great way to teach these foundational skills.

• The first phase of PECS is to teach the initiation of a picture exchange. I love the focus on initiation and feel it is important to avoid developing prompt dependency. You are not supposed to use any verbal prompting. You are to entice the learner rather than prompt them. The use of a second person acting as the physical prompter during Phase 1 is not the same as facilitated communication (if you are doing it correctly). Some people have expressed concern that having a physical prompter is taking away the learner’s autonomy. In my experience with PECS, I am following the lead of the learner by watching for their initiated reach and using physical prompting to shape the reach for an item down to the picture to facilitate the picture exchange. Typically, I only need to use physical prompting for the first few requests before the learner understands how to give the picture to the communication partner to obtain the desired item. The goal is to fade any prompting as quickly as possible.

• Typically, when using PECS, I focus on the first 3 phases to focus on the development of joint attention, initiation, persistence, and picture discrimination. Here are the first 3 phases of PECS:

1. Teaching the exchange with a single picture

2. Teaching the exchange with a single picture, adding distance, and generalizing the skill across people and environments

3. Teaching picture discrimination between 2 or more pictures (I spend a lot of time at this phase to continue generalizing across settings and people for a variety of items)

• The strategies in these first 3 phases will make sure the learner takes the responsibility of exchanging the request with the right communication partner. Have you seen a student using a device and repeatedly hitting the button without getting the attention of anyone? It’s almost as if they think it is a magical button that will get them what they want (who needs people?) Even if a team is not using PECS, I may refer them to some of the strategies from PECS to teach initiation, joint attention, and traveling. Traveling is when the learner must travel to get the picture and then travel to give the picture to the right person. This is an important skill weather your student is using pictures or a device. You want to make sure the student is exchanging information with a partner and not just interacting with a device.

Nancy Cera

Brookville Elementary, Brookville

• When teams are struggling to teach picture discrimination, I often refer them to the PECS manual Phase 3 for some great ideas for teaching, assessing, and reinforcing picture discrimination. Picture discrimination is critical if you plan to use any kind of picture-supported communication. 

Amy D'amico
Learning Center North, MCESC

Watts Middle School, Centerville

• Phase 4 of PECS is sentence structure. This is where you add the “I want__”. Once I have developed strong joint attention and the learner can discriminate between many pictures across environments, I may start to transition to other more robust systems and introduce core words. 

Sara Moore
Bell Creek Intermediate, Bellbrook

• While I am a big fan of teaching core words, some students need to start with more concrete language using highly motivating nouns for exchange. The first 3 phases of PECS will focus on the use of highly preferred items. These nouns are considered fringe words (ball, chip, iPad) and are used in a very concrete way to teach the power of pictures for communication. Core words are introduced in phases 4-6 and can be more abstract but are used more frequently in our language and can be combined to have many different meanings. (I, want, see). Descriptive words are also introduced in Phase 4. 

• If you believe your student needs more of a Gestalt language approach, you can use the strategies of PECS to teach the foundational skills (exchange, initiation, traveling, discrimination) while introducing core words. I like the use of Aided Language Stimulation, a strategy that focuses on the frequent modeling of words on a core board without expecting the learner to respond. This can be done on a static core board or an AAC device. This combination goes against the PECS protocol but if you are not formally using PECS, you can still use many of the PECS strategies to meet the needs of your student. 

Remember, any approach you take to developing functional communication must meet the specific and unique needs of the learner. Get to know your student and ask yourself the following questions to determine if your student would benefit from the strategies of PECS:

• Do they struggle with joint attention and initiation?

• Are they highly distracted by technology only focusing on the device and not the partner? 

• Are they destructive by often throwing or pounding on a device? 

• Are they unable to use pictures in a meaningful way or discriminate between pictures?

• Do they rely on others to initiate the use of the device and travel with the device to get the message to the right person?

There are so many factors to consider when choosing the communication mode and strategies to try. Collaboration between the classroom team, SLP, family, and outside therapy is needed. The most important thing is that you try something! You can visit these resources to get more information and assistance when assessing your student’s communication and AAC needs:

• AAC Autism Internet Module

• AFIRM AAC Module

• PECS Autism Internet Module

• AFIRM PECS Module

• OCALI SIFTS AT Decision-Making Tool

PECS is an evidence-based practice. Here is a link to ASHA’s AAC Evidence Map and PECS Evidence-Based Practice Review

A-LIST Spotlight: Intervention Specialist Heidi Horner from Miami County ESC

Miami County ESC Intervention Specialist Heidi Horner at Cookson Elementary in Troy has been nominated to our A-LIST because stepping into her classroom is like entering a realm of exceptional evidence-based practices! Throughout her coaching journey with the ACT Team, Heidi has consistently shown an admirable willingness to embrace constructive feedback and transform new ideas into her own wonderful classroom practices. What truly stands out is her infectious positive attitude and her remarkable ability to collaborate with her classroom staff and the families she so passionately serves. With her students always at the forefront of her mind, Heidi tirelessly strives to meet their needs, never backing down from a challenge. She is constantly engaged in problem-solving, and we are particularly impressed with her initiative to support students in a deeply individualized way, ensuring that both she and her staff are truly addressing their needs. Heidi's leadership style and dedication to teaching deserve not only to be celebrated but also to be wholeheartedly recognized! Congratulations, Heidi!

We reached out to Heidi so that she could share some of her fabulous best practices for today's feature. Keep reading to see Heidi's classroom in action!

Transition Supports

Heidi supports her students by providing a variety of visual and sensory supports during transitions. She includes these transition supports next to her classroom door for easy access when entering and leaving the room. Some of her sensory supports include a weighted shopping cart and a weighted bookbag (panda bag).

For visual supports, she uses a location-based schedule where students match an icon to a corresponding picture by placing it in the pocket or sticking it to the velcro. Another visual support is her ziplock bag of walking feet which can build positive momentum and keep a student moving forward as the feet are laid out.

   

Restroom Transition

One important transition for students each day is using the restroom which requires leaving the classroom and traveling in the hallway. Near the door, Heidi has several restroom supports including a switch for every student to push that says "I need toilet" to reinforce communicating for the restroom as well as a social story.

Communication Supports

In addition to the switch for asking for the restroom, Heidi has many other communication supports in her classroom including requesting boards (see reinforcement below) and picture supports.

Communicating with families is also an important part of Heidi's classroom. She sends home this communication sheet daily.

Academic Supports

Heidi serves a diverse group of students with various needs. She provides many different types of academic supports such as her 1:1 teacher area where she can work on individualized goals and her adapted calendar books with cute sign in activity for Morning Meeting. In her classroom, Heidi uses the Unique Learning System curriculum to provide modified access to content standards for her students.

           

     

Structured Work Stations

Another way Heidi meets the unique learning needs of each student is through the use of structured work stations. Heidi shared "I like individual stations because it allows for more personalization. It allows students to have their things all in one space. Oral sensory necklaces, noise canceling headphones, choice board with individualized reinforcements, mailboxes, and anything specific to that child that needs to be kept in "their space". I use the Reinforcement Inventory Checklist as a reference for each student's choice boards. I give parents the Reinforcement Inventory Checklist on Open House night, so that parents can fill it out at the beginning of the year. I keep the checklist in their individual IEP binders to reference when I want to change up their choice boards."

For her structured work stations, student task boxes are all numbered or lettered. The date is recorded on the "Mastered Task Box List" when a student has mastered the task. Students keep the same tasks in their 1,2,3's for one week. We switch them out at the beginning of each week.

She has even incorporated portable structured work stations that can be taken to general ed classrooms for inclusion, to specials, or to related service sessions.

Teaming with Paraprofessionals

Another area in which Heidi excels is collaborating and communicating with her paraprofessionals. She has a great prep station for upcoming materials. Heidi shared, "y paras can always check the SPED prep station for "projects" that need to be completed (such as laminating or making copies), in the mornings during our planning/prep time before the students arrive."

Her paras also have their own "Support Sessions" table where they are in charge of weekly activities. Next to the 'Support Sessions" table, they keep a weekly checklist for the "must dos" for the week. "Must dos" are the assignments that all students must complete each week. The "must dos" this year are the weekly craft, the weekly scholastic magazine, and one Moncure letter book.

Classroom Organization

One way that Heidi stays organized is through using color-coding. Heidi shared, "I used color coding this year. Each student's IEP binder, seat at circle, colored popsicle stick for their bird sign-in, and any other time that it makes sense to color code. ie. Student "A' is blue. His IEP binder is green, his cube chair is blue, his bird popsicle stick is blue, etc. If I am passing out trays for sand or something like that he would get a blue tray, etc."

Reinforcement

Heidi has some wonderful reinforcement systems in place including:

• Interest specific token boards
• Rules at group to earn Happy Chappy and the communication book to make a choice of what color/smell they like.
• Choice board for reinforcement motivation (interest specific for each student based on answers from the Reinforcement Inventory Checklist)
• All Done Bin and Waiting Mats
• Edible reinforcement compartments for steps of transitioning on to the bus

     

Sensory Supports

Last but not least, Heidi supports her students' sensory regulation through proactive supports such as her heavy work station and classroom sensory area and reactive supports like her calm down choices and corresponding book.

A very special thank you to Heidi for welcoming us into her classroom and being such a wonderful partner to the ACT team. We are excited to share these ideas with additional educators!