Attendees:

B, Ass. Sp Ed Director for district

Rosie, Leelo's in-class one-on-one aide

CB, paraprofessional aide in Leelo's class

SND District OT

KLA, District OT

KD, EyeCandy Learning Center (ABA Agency contracted by district)

Babysitter A, Leelo's aide/babysitter

Supervisor M, Leelo's ABA in home program director, 3 years

Squid Rosenberg, Mom

Seymour Rosenberg, Dad

Sage, Leelo's private SLP

Ms. M., Leelo's teacher

Anique, District SLP

Tarzania, Cloy Roud School Psychologist

Squid:

Informally as Sp. Ed Dept. rep not yet at meeting: OTs, we'd like for Leelo to learn to take bites of his food rather than tearing everything up into bite-sized pieces and then eating it with his hands.

[B, Asst. Dir of Sp. Ed, arrives. He will be standing in for MM, Dir. of Special Ed]

Who has reports to share?

KD's report from EyeCandy learning:

His agency focuses on behaviors that interfere with learning rather than deficits.

Leelo: KD (parent interview) and K (onsite assessment) didn't see a lot of excessive behavioral problems, tantrums or aggressiveness. Saw as child with a lot of significant deficits. Saw Leelo during downtime, on his own agenda.

It's not that Leelo doesn't understand what is being said to him, but rather that in an unstructured environment it is harder for him to respond to instructions.

Based on presence of and reported success with home visual scheudule, Leelo would benefit from visuals to help him organize his language, esp. during anxiety or stress, it is difficult for Leelo to get out good language. EyeCandy uses a lot of color-coded visual strips from Emily's model (? Not sure what this is).

Uses the "I want" stem a lot, which minimizes his ability to use all the language he might have, it is limiting. Visual support will teach him how to better organize himself, teach him structure of language, which will then teach him more complex language with novel sentences, on his own too.

His communication; Leelo understands the power of communication, eye contact, verbal requests.

Need to focus on his communication, in terms of demanding more, asking for clarifications, that's what a lot of communication does, kids at age are using communication 1000's of times a day, want to help Leelo do that.

Need to focus on learning to learn skills. Leelo can imitate, esp. when motivated. They didn't see a lot of response to cues in his environment. Typical kids observe and watch and imitate everything, that's how they learn. What they'd like to see is Leelo condition his imitation better. Right now he's imitating just to imitate, rather than when we want him to or need him to imitate. This ability to learn from environment and also to respond to social cues usually emerges when children are younger than one and is a big deficit for Leelo.

KD's agency wants to get kids to learn on their own so that they don't need behaviorists.

Leelo is not paying much attention to world around him if he doesn't WANT to pay attention and learn. KD wants to get Leelo onto social motivation and anticipatory excitement. Leelo will want to observe and watch more, and eventually imitate. He has these skills but is not using them to learn on his own.

Want to develop more social motivation to capitalize on learning skills.

Play: schedule board in place is very important. Open ended stuff is very hard for Leelo. Leisure skills are very important for him, to have something to do while he's on his own.

It was great. He has a lot of skills. Recommend continuing with a program for him.

In that 0 - 1 year age level there are some skills they'd focus on, social stuff, floor time and RDI stuff.

EyeCandy is a behavioral company, use Discrete Trials, it is their foundation, but it's not everything. But it is a "make learn" environment, they want to transition to a "make to learn" program.

If he wants to pay attention and he wants to learn, then he will.

Understands that a lot of these things are being worked on.

Recommend 15 hrs/week along with classroom placement?

KD:

We recommend 25-30 hours total program. So if getting 20 -25 in Kinder, then 10 -15 support outside of class.

EyeCandy looks at selves as supplementary system to classroom. They look at classroom placement and then look at additional services needed, come up with goals.

Squid:

Leelo's kindergarten is 16 hrs week.

KD:

So at least 15 hrs then. Have to look at progress in classroom first.

We haven't started.

How might program look?

KD:

Communicate with teacher all the time (2x week) to support them. At least to start, then taper off to monthly. Make sure on same page as teacher.

KD provides three-tiered system: director, program supervisor who does part of 15 hrs but is more liaison with OT and ST as well, they would communicate with teacher. Email is good. Every two weeks hold meeting with family, etc. OT, etc.

[Not mentioned but it is assumed that there is also on-site therapist doing actual therapy]

Tarzania:

Is there an amount of consultation time?

KD:

Yes, it is built into the contract, but we always go over.

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Squid:

Discusses awkwardness of two ABA agencies. PS from pre-K special ed contracted with EyeCandy in case Supervisor M, who has been running Leelo's program for three years, was not able to get her NPA in time. However Supervisor M's NPA was awarded two days ago.

KD's work was great but given all the transitions happening in Leelo's life: New school, new teacher, new aide, different OT, different ST, etc., we would like to keep ABA program in home intact with current team of Supervisor M and Therapist L (the latter has been Leelo's ABA therapist since August 2003).

Do you agree with KD about number of in-home hours needed?

Supervisor M:

Concurs with KD about number of hours in home.

[Squid: Note that Therapist L is scheduled for 14 hours/week in the afternoons for this school year]

How would communication with classroom happen?

Supervisor M:

Hasn't visited classroom yet. Because specific goals hadn't been drafted yet, would like to see them before can make recommendations.

Can we hear about classroom? Share strategies about working with Leelo, seems like a priority since school has already started?

Need to decide how ABA and relationship with agency will work. Right now Supervisor M will work how with classroom?

Supervisor M:

Needs to register with county of Saint Matthews. NPA registered with SF already.

KD:

School will send out letter to Supervisor M asking for everything needed.

Will say that NPA is on its way then.

KD:

As his services will not be needed, will leave as attendance at remainder of meeting violates Leelo's privacy.

Everyone thanks KD. KD leaves room.

SHIFT TO CLASSROOM DISCUSSION.

Ms. M:

Leelo has 1:1 aide, which is Rosie. Rosie is currently piggybacking on Babysitter A's experience.

Supervisor M:

Aide wasn't written into IEP.

Sage:

Not written in. Implied. Can we formalize it.

Ok, next.

Ms. M:

Leelo's class now has a schedule. Written on board behind me.

Will move to visual?

Ms. M:

Yes, will move to visual schedule, ten minutes of activity followed by ten minutes of another activity because these kids require lots of activity of movement, changes of scenery and venue.

Leelo himself has become more settled today, third day in, seeing positive responses, eye contact, relating to adults in classroom.

Sage:

What are kids calling you?

Sue:

"Sue." Anything else is difficult.

Tarzania:

Agreed. Too complicated.

Sue:

Leelo is getting accustomed to Rosie, she's doing a very fine job.

What does being Leelo's 1:1 aide look like? What's the job's nature? Are you [Rosie] literally with him the entire time?

Babysitter A:

She suggests extremely close proximity until Leelo's used to new setting. Always very very close to him.

Sage:

What is close?

Babysitter A:

Right next to him for hand-over-hand and prompting.

Supervisor M:

KD didn't see behavior problems, but Leelo does have them. Very strong, fast, aversive to many requests, protests requests. Behavior usually particularly bad during winter.

Seymour:

Leelo understands door locks, window locks, will escape. Does have some hitting and scratching and pushing behaviors, especially when others are upset.

Babysitter A:

Leelo's been tolerating the in-class crying really well. There's been lots of it. Babysitter A's been modeling for Rosie a lot in terms of getting Leelo out of that environment.

Supervisor M:

What is the 1:1 work? Stations?

Ms. M:

Patterning, paraprofessionals or Ms. M help and they can divide them up into groups.

Stations are written in schedule twice because there are two groups, but each child only does stations once.

Supervisor M:

Any integrated recess time or other time with typical peers?

Ms. M:

Not yet. Working on it.

KLA:

Is this an SDC class?

Ms. M:

Yes. Autism Kindergarten.

Supervisor M:

Leelo will really benefit from integration with typical peers. He has a facilitated playgroup at home. Since March, he and his friend Navidad have been doing well, especially now that Navidad is over the novelty of going to Leelo's house and getting to play with his toys. The playgroup times that are nicest for Leelo are snack, sharing snack when he is motivated to use his language. Also writing and art is soothing for him so that is a good time.

Seymour:

Leelo wasn't interested in writing and art even two months ago.

Supervisor M:

With prompts, Navidad would compliment Leelo's work, and he'd show it to her, with prompt. Leelo loves her.

Squid:

Leelo was at Iron Gate, a typical preschool, until Feb. 2006. Then went to ALSO in Deadwood Shores for the remainder of the school year, and summer school.

Seymour:

Communication b/t therapist and classroom: What will communication between school and families look like?

Ms. M:

Communication log gets sent home every day. Use on daily basis. Stays in folder, comes in backpack ever day. written form. Will be checked every day. Can use it for a variety of things.

Seymour :

Likes logs at home in terms of figuring out what skills Leelo is currently working on.

Supervisor M:

ABA team meets at home meet every 2 - 4 weeks. Then meeting minutes get sent out with all the info to entire team even those not present. Working on strategies, etc. Very much want to work with classroom on developing strategies and being consistent. Historically this has worked well for us.

Current strategy, decided on in class, is to say stop rather than "no biting" or "no hitting, " which emphasized "biting" and "hitting." Instead in classroom developed, "stop," which was very effective.

Another possibility since this is such a new class is to set up some trainings. If we can find a chunk of time to do 1-2 hour trainings; to reduce bolting and wandering, using language to engage and access materials.

Would this helpful?

Ms. M:

Yes.

Supervisor M:

My report has written down skill levels for Leelo. Want to hear it?

Parts of it, yes.

Supervisor M:

Expressive and receptive deficits. As KD said, Leelo needs ongoing help with his "learning to learn" skills.

Leelo learns in many contexts. We go in bedroom, on floor, play language games under covers. etc. Not just at table.

Specifically we'd like to see him transfered mastered skills to classroom.

e.g. Leelo can imitate ANY 1-step task. Would like to see him imitate in class. He has hard time generalizing. Has hard time using skills in non-home environmnets.

Ms. M:

was doing imitations today.

Supervisor M:

Leelo can imitate silly faces, for example. But we didn't see a lot of spontaneous activity and imitation in the ALLS classroom. We'd like to see it here.

Leelo does very nicely in 1:1 academic setting. Sorting, for instance. Initially very difficult, understood what the category name was but couldn't sort.

Started Adderupp recently. Several trials with different dosages, is currently on 5mg extended release which is working nicely. Used to max at sorting five objects in two categories. Now can do 3 categories with 15 objects.

Leelo also (which KD didn't see) does a lot of commenting. On what he sees, has, and hears. Still don't see him doing it a lot in class.

Babysitter A:

Today in class Leelo wouldn't do 4 block imitation which he has mastered at home.

Squid:

Lizzie, private OT, says Leelo's motor planning is very difficult under stress like new classroom.

Supervisor M:

Leelo also has difficulty combining language and actions.

Seymour:

Leelo follows 3-part directions at home very well. Doesn't always comply, but can.

Squid:

But you won't see it in the classroom because he is stressed.

Important to note that Leelo's receptive language is better than his expressive.

Supervisor M: Note that in ALSO he started in March but didn't follow teacher directions until June.

Better to sit behind him so that he doesn't rely on people in front of him for directions and prompting.

At home we are working on self-care and directions. He is working on toileting on a schedule. Can hold urine, has not mastered bowel movements.

Once he starts the toileting series of actions, he can go through the entire routine independently. He can do the entire task from flushing, pulling up pants, etc. through washing hands, by himself.

Prompt him from behind is good again.

Been working on fixing snack and playing games by himself. Very challenging, hasn't cracked the code.

Between organization and distraction it is hard for him to play independently.

[Babysitter A has to leave]

Squid:

Gave example of Leelo's intuitive understanding and then perseverative play with a ladder/slide Mont. bay aquarium play area; Leelo likes to find circuits because they are predictable and he knows what he's supposed to do.

Rosie:

Has seen this at school, Leelo is already showing some preferences for retracing previous routes exactly.

Squid:

It may be that the Adderall has cleared out some of his ADHD symptoms and that now we are seeing some of the autistic symptoms, such as desire for routine.

Seymour:

He was too foggy before, now is aware of his environment, trying to take more control. Might be being a kid rather than an autistic kid.

Tarzania:

Could be other symptoms emerging after meds, not just autistic ones; heightened awareness of what's going on in life.

Squid:

Since adderupp, needs fidget at all time.

Ms. M:

Says Leelo doesn't need fidget all the time in classroom Puts in pocket.

Tarzania:

Fidget changes every couple of weeks?

Squid:

Yes.

Ms. M:

Let's see how he can cope without fidget.

Sage:

Sometimes he can do a whole speech session without fidget, sometimes needs it the whole time.

CB:

We're moving around very quickly in class. He doesn't really have time to stop and realize that he needs his fidgets.

Ms. M: We're moving every 10 - 15 minutes, is preoccupying him and other students. As he matures and his focus settles, his time on task will increase, and need for fidget or other preoccupier will be lessened.

Anything else you need to know, Supervisor M?

Supervisor M:

No, not until have a clearer idea of class and what sort of help will be helpful. Will visit class tomorrow.

OT needs, what was it that the parents wanted?

Squid:

We'd like to increase OT form 30 to 90 minutes per week, because 30 minutes in previous IEP was based on him getting 60 minutes push-in through ALSO preschool.

KLA:

See big need for help with snack time, starting to enjoy art time. Maybe SND or KLA being here during snack time would be good. Goal to be making this class very sensory-enriched. Trampolines, seat fidget cushions, etc.

SND:

Main thing is that KLA can provide consultation to the teacher so teacher can provide services 5 days a week even when OTs aren't here. Build sensory program, with sensory breaks, into classroom.

Is that something to integrate into class's schedule?

KLA:

Sure. e.g., 5 minutes before break or circle or fine motor, so deep pressure would be good. Good to have schedule so Leelo can't just go wild.

Squid:

Leelo needs a lot of activity, it helps keep him calm(er). In past six months has burned through two trampolines.

KLA:

It might be that regulation is an issue, limit time on OT tasks, trampolines, etc. that Leelo can't just go wild. If he has total access he won't know when to stop.

SND:

Want to integrate OT into classroom as much as possible. Otherwise Leelo has to be taken out of classroom and taken via bus to OT room at FDR school.

Squid:

I could bring him to FDR...

KLA:

Pull out not necessary and bussing him to motor room would be a bad idea.

Sandy:

Motor room only at FDR. Will set up this classroom and Leelo will get 1:1 OT here, onsite.

Seymour:

So 1:1 and classroom experience are not entirely different?

Sandy:

Push-in services will be more what is happening.

Seymour:

Leelo's fine motor is not good. He does not use his fingers independently. His grip is more like having one thumb and one very wide finger.

Rosie:

That is how he ate his croissants today.

KLA:

Snack time would definitely be a good time to come.

How do you want to word it for the IEP? Could you put it individual/group? Schedule doesn't really matter. We do it per child. Frequency, etc. based on goals.

Supervisor M:

Learning needs dictate time spent, right?

Sage:

Usually establish goals and then determine frequency. Lots of changes with new IEP over year.

We will be re-meeting for goals, having another IEP after everyone has worked with Leelo for a few weeks and can better assess his needs.

KLA:

Please write in OT at 45 minutes for now so we can start seeing him. Will come back and collaborate on goals, and then will adjusts time accordingly.

Please write 45 ind'l/group so we can start going right now. We need to find space on this campus. Maybe the gymnasium. We are used to having to find space. Maybe playground.

Seymour:

We are going to put in this IEP 45 minutes ind'l/groups, will lock this in now, goals will determine changes in future.

Tarzania:

It's understood that goals and services are subject to change.

Seymour:

Just want to be clear on what Ind'l/group means, have to be careful that doesn't go all group.

KLA:

Just means that we're evaluating him, so legally has flexibility for other kids to interact if Leelo is ready for group work.

Will review for now and then in future determine needed hours.

KLA:

When should we meet again? Within the month?

Within the month. Need to come up with specific date.

Sage:

What about Lizzie's report? [Private OT consult] When will that be and can you get it to KLA/SND?

Squid:

In-home evaluation is on Sept. 1. Yes. Will get to KLA via email.

OT start date?

KLA:

Next week.

Ms. M:

Email or call me, to set it up. Looking forward to it!

Finishing up on ABA. 15 hours outside of classroom?

Supervisor M:

Yes, plus me providing 3 - 5 hours of consultation. Perhaps we can meet (B) afterwards to discuss.

Coordination, team meeting, data analysis is outside of 15 hours.

[Seymour leaves to go pick up Iz from school]

Squid: What about Speech services?

Anique:

60 minutes, excited to hear how he's motivated by snacks, she finds the kids work well with snacks. Understand that lots of them have aversions. Hopes that peer pressure will work.

Tues-Thurs, push in services around 9:30. 1 day/week. 30 minutes per week also individual time.

Ms. M:

Will find out if any kids in the class food allergies.

Squid:

Individual speech is Push in?

Anique:

We'll discuss during next IEP. Will be here four days per week. She has a room.

Squid:

So will spend next month observing and getting to know him?

Anique:

Yes. Will hope to start observations tomorrow. Basically, informally will start right away.

Supervisor M please register with the county today.

As far as start date for ABA program, when district will be taking over? Need to get contract, all that certification? A week?

Supervisor M:

Leelo's program is ongoing. My own certification for district is just a matter of processing, right?

A week seems reasonable.

Supervisor M:

Will email B proposal including consultation and training hours for classroom teachers and aides.

Sage:

How about APE (adaptive physical education) eval?

KLA:

But I thought Leelo has good gross motor?

Squid:

Sort of, but can't throw ball, etc. He does fine with climibing swinging, etc., teeter totter, but not with sports.

KLA, B:

How about APE screening?

Squid: Okay.

By the way, 1:1 aide was written into 8/16 IEP.

Sage:

Supervisor M's meeting minutes are helpful to everyone on Leelo's team, everyone wants a copy.

Leelo's next IEP wil be Friday Sept 15 1:30: will start with non-speech goals, Anique will join us at 2:30, here at Leelo's classroom.

Anique will come with goals.

KLA:

Need to get Lizzie's goals before 9/15.

Sage:

Will know more about inclusion opportunities at next IEP. Specifically Leelo is good at snack and art.

Will formulate ABA plan with Supervisor M over next two weeks.

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B: reads IEP summary.