text:
Autism Spectrum Disorders: Guide to Evidence-based Interventions
- Cornelius Peters
- 3 years ago
- Views:
1 Autism Spectrum Disorders: Guide to Evidence-based Interventions A 2012 CONSENSUS PUBLICATION Sponsored by the Thompson Foundation for Autism; the Division of Developmental Disabilities, Missouri Department of Mental Health; the Office of Special Education, Missouri Department of Elementary and Secondary Education; and Mercy Children s Hospital St. Louis and Springfield
2 This publication was developed as a result of a partnership between the Thompson Foundation for Autism, the Office of Special Education of the Missouri Department of Elementary and Secondary Education, the Division of Developmental Disabilities of the Missouri Department of Mental Health, Mercy Children s Hospital St. Louis and Springfield, and members of the Missouri Autism Guidelines Initiative. All rights under federal copyright laws are held by the Division of Developmental Disabilities except for those previously published materials included in this document. All parts of this publication, except for previously published materials credited to the authors and/ or publishers, may be reproduced in any form of printed or visual medium. Any reproduction of this publication may not be sold for profit or reproduction costs without the exclusive permission of the Division of Developmental Disabilities. Any reproduction of this publication, in whole or in part, shall acknowledge, in writing, the Thompson Foundation for Autism, the Division of Developmental Disabilities, the Office of Special Education, and Mercy Children s Hospital St. Louis and Springfield. This publication is available at no charge at Excerpts from previously published articles included in this document are reprinted with permission from the author and/or publishers and are for personal use only. They may not be reproduced without the express written consent of the author and/or publisher. Funding for the printing and dissemination of this Guide was provided in whole by the Missouri Foundation for Health. The Missouri Foundation for Health is a philanthropic organization whose vision is to improve the health of the people in the communities it serves. MO Division of Developmental Disabilities Department of Mental Health
3 Autism Spectrum Disorders: Guide to Evidence-based Interventions A 2012 Consensus Publication guide to evidence-based interventions 3
4 Missouri Autism Guidelines Initiative Oversight Committee Joan E. Armstrong, MS, LPC Joel D. Bregman, MD Janet E. Farmer, PhD, ABPP Dawn Huber, PhD Michele Kilo, MD John F. Mantovani, MD Vicki McCarrell, MA Kim Goodrich Ratcliffe, EdD Advisory Committee Janice Amleshi Sally Becker, OTR/L G. Elaine Beussink, MA, CCC-SLP Rebecca Blackwell, MA, BCBA, LBA Cynthia Bliem-Sharp, MS Amy Buie, MEd, BCBA John N. Constantino, MD Marilyn Cox Julie A. Donnelly, PhD Beth Emmendorfer, EdD Lisa Fowler-Koeppe, OTR/L Jenny Frisbee, MA, BCBA, LBA Jennifer Gray John M. Guercio, PhD, BCBA-D, CBIST, LBA Lauree Head Connie Hébert, MS Ed Susan Henderson, MS Patricia Kopetz, EdD Ronald Kruse, EdD Julia LePage, MS, BCBA Lori Lewis, MS, CCC-SLP/MAC Melinda Long, MS, CCC-SLP Jeanne Marshall, MEd, MA, BCBA, LBA Brenda Martien, MS, CCC-SLP/MAC Stacey Martin, MA, MAC Rolanda Maxim, MD Micah Mazurek, PhD Donald McCary, MS, BCBA Vicky Mieseler, MS Victoria Moore, PsyD Kaye Otten, PhD Colin M. Peeler, PhD, BCBA-D, LBA Shula Portnoy, MD Claudia Preuschoff, MD, FAAP Jena Randolph, PhD Gregory R. Robinson, PhD Robin Russell Duru Sakhrani, MD Kristin A. Sohl, MD, FAAP Todd Streff, MS, BCBA Keenan Stump, MS, SLP JoAnn Youngblood, PhD Laine Young-Walker, MD Staff Karen Bodenhorn, MPH, Project Director Dawn Huber, PhD, Senior Project Staff Writer Lee Falk, BJ, Communications Director Ron Huff, PhD, Senior Project Staff guide to evidence-based interventions i
5 Table of Contents Acknowledgments... iv Chapter 1: Introduction Introduction...1 The Need for This Guide... 3 Overview of Evidence-based Practice... 5 Evidence-based Practice as a Framework for ASD Intervention... 6 Systematic Reviews Provide the Best Available Research to Support Evidence-based Practice...7 Research Reviews that Inform This Guide... 8 Core Values of the Missouri Autism Guidelines Initiative... 9 Family-centered Care... 9 Early Intervention and Ongoing Support Informed Professional Judgment The Interdisciplinary Team Community Collaboration How to Use This Guide Chapter 2: Evidence-based Intervention Introduction Importance of Community Collaboration...15 Evidence-based Practice Provides a Framework for Effective ASD Intervention Best Available Research...17 Individual Characteristics...17 Professional Expertise The Intervention Process Step One. Conduct Assessment Essential Components of Assessment Step Two. Develop Intervention Plan...22 Component One. Identify Goals...22 Component Two. Select Interventions...24 Component Three. Determine Progress Monitoring Procedures...24 Step Three. Monitor Progress...25 Families and the Intervention Process...26 The Intervention Process Across Service Delivery Systems...27 Special Considerations for Service Delivery Systems...30 Special Considerations for Healthcare...30 Healthcare Case Example...35 Special Considerations for Other Service Systems...36 Other Service Systems Case Example...37 Special Considerations in Public Education...39 Case Examples Illustrating the Intervention Process in Public Education Systems...45 Transitions Between Delivery Systems...50 Medical and Healthcare Issues...50 Educational Transitions...51 Transition from School to Adult Services...52 Transition Case Example...53 ii autism spectrum disorders
6 Chapter 3: Research Findings Introduction...55 Importance of Systematic Reviews Overview: Six Systematic Reviews Cross-cutting Implications...62 Challenges of Drawing Conclusions Across Reports...62 Methodology to Identify Effective ASD Interventions...62 Effective ASD Interventions...63 Goal Areas Targeted by Effective ASD Interventions...71 Ineffective ASD Interventions...73 Harmful ASD Interventions...73 Other ASD Interventions...74 Need for Additional Research...74 Looking Ahead Toward New Research Description of Effective ASD Interventions Chapter 4: Summaries of Research Reviews Introduction Review Summaries National Professional Development Center (NPDC) Centers for Medicare and Medicaid Services (CMS) National Standards Project (NSP) Agency for Healthcare Research and Quality (AHRQ) Stanford Autism Research Team (StART) Comprehensive Treatment Models (CTM) Bibliography Appendices Appendix A: Missouri Autism Guidelines Initiative Appendix B: Glossary of Terms and Acronyms Appendix C: Effective ASD Interventions by Domain Appendix D: Resources for Parents and Professionals Appendix E: Sample Intervention Plan Index of Intervention Names case examples Healthcare Case Example...35 Other Service Systems Case Example...37 Case Examples Illustrating the Intervention Process in Public Education Systems...45 Transition Case Example...53 guide to evidence-based interventions iii
7 Acknowledgments Autism Spectrum Disorders: Guide to Evidence-based Interventions is the result of a public-private partnership between the Thompson Foundation for Autism; the Division of Developmental Disabilities, Missouri Department of Mental Health; the Office of Special Education, Missouri Department of Elementary and Secondary Education; and Mercy Children s Hospital St. Louis and Springfield. Working together as the Missouri Autism Guidelines Initiative, we are proud to have initiated the collaborative process between parents and professionals which has resulted in our second publication, the companion document to our 2010 publication, Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment. Together we thank and gratefully acknowledge: n Individuals and families who live with autism spectrum disorders (ASDs) and who are dedicated to identifying and securing high-quality, evidence-based, effective interventions in their communities. We are grateful for the thoughtful input of the parents who participated in the development of this document. As with the Initiative s first publication, the insights of parents have made this book better and more accessible to families. n The community of professionals, including healthcare professionals, educators, and other service providers, who partner with families and each other in delivering quality ASD care. The intervention process is enriched through their professional experience and their knowledge of each family they serve. n The ASD researchers who produced the six systematic research reports on which this document is based, especially those who led symposia for the Missouri Autism Guidelines Initiative to inform our thinking. These national experts challenged us to think more broadly and to expand our work to include the complex cross-cutting summaries that families and professionals most need. Lynne C. Huffman, MD, Associate Professor, Pediatrics, Stanford University School of Medicine and leader of the Stanford Autism Research Team (StART), Palo Alto, CA Samuel L. Odom, PhD, Director of Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill and Principal Investigator of the National Professional Development Center on Autism Spectrum Disorders Hanna C. Rue, PhD, BCBA-D, Director of Applied Research and Evidence-based Practice at the National Autism Center, Randolph, MA Jeremy Veenstra-VanderWeele, MD, Assistant Professor of Psychiatry, Pediatrics, and Pharmacology, Vanderbilt University, Nashville, TN n Members of the Missouri Autism Guidelines Initiative, under the leadership of the Oversight Committee. These Missouri parents and professionals worked together for more than a year through a collaborative process focused on understanding the scope of the six systematic reviews and formulating the overall content and core values of the Guide. iv autism spectrum disorders
8 n The professional staff who worked to develop the project s consensus process, drafted the document, and built understanding of the research: Karen Bodenhorn, MPH; Dawn Huber, PhD; Ron Huff, PhD; and Agnes DeRaad, MA. Once again, their contributions to this project exceeded all expectations. n The Missouri Foundation for Health, which generously supported the communication, publication, and dissemination of this Guide under the guidance of Lee Falk and Laura Burns Gericke. A special note of thanks goes to the directors of the Thompson Foundation for Autism, led by Bill and Nancy Thompson. Their vision, time, talents, and financial support are creating partnerships and collaborations that are truly improving the lives of those with ASDs and their families in Missouri and beyond. Bernard Simons Division of Developmental Disabilities, Missouri Department of Mental Health Ron Ashworth Mercy Children s Hospital St. Louis and Springfield and Thompson Foundation for Autism Gay Tompkins Thompson Foundation for Autism Stephen Barr Office of Special Education, Missouri Department of Elementary and Secondary Education guide to evidence-based interventions v
9 chapter 1 Introduction chapter 1 guide to evidence-based interventions 1
10 Introduction This Guide, produced by the Missouri Autism Guidelines Initiative, describes evidencebased interventions for individuals with autism spectrum disorders (ASDs) based on six recent nationally recognized systematic research reviews. The document provides information and tools to support individuals with ASDs and their families and to assist healthcare professionals, educators, and other community-based service providers in making informed decisions about selection, implementation, and monitoring of ASD interventions. Throughout the Guide several key concepts emerge regarding evidence-based interventions. n Emphasis on evidence-based practice. Evidence-based practice has become the current benchmark for professionals in medicine, psychology, education, and other healthcare fields. Evidence-based practice includes a combination of the best available scientific evidence, professional expertise, and understanding of client characteristics. n Scientific research informs evidence-based practice. Review of evidence from scientific research is the foundation of evidence-based practice and decision making regarding interventions to consider and those to avoid. Current research evidence provides important information about effective ASD interventions, but more research is needed. (For example, research on interventions for adults with ASDs is extremely limited.) Lack of the highest quality research data about an intervention does not in itself preclude consideration of that intervention. n Evidence-based practice is informed by professional expertise. Although scientific research is critical to evidence-based practice, professional expertise and judgment guide the interpretation and application of available research evidence. n Evidence-based practice includes consideration of individual characteristics. Intervention decisions for individuals with ASDs are not based solely on scientific evidence and professional expertise, but are made in the context of the strengths, concerns, values, and preferences of the person with an ASD and his or her support network. This network includes the family, the professional team, and available community resources. n Importance of systematic research reviews. The rapid growth of the scientific literature on ASDs makes it challenging for families and practitioners to stay up-to-date with research findings. Systematic reviews play an important role in summarizing and synthesizing the knowledge base on ASD interventions. To provide individuals with ASDs, their families, and professionals with the most current evidence to guide intervention planning and implementation, this project presents findings from six nationally recognized systematic research reviews on evidence-based ASD interventions. 2 autism spectrum disorders
11 n Effective ASD interventions can lead to improved outcomes. The systematic reviews presented in this Guide describe effective evidence-based interventions that have produced positive outcomes for individuals with ASDs. Outcomes are maximized when interventions are matched to individual characteristics and begun as early as possible. chapter 1 The Need for This Guide Autism spectrum disorders (ASDs) now affect approximately 1 in 88 American children (CDC, 2012). ASDs have lifelong effects on individual functioning in areas such as learning, relationships, and independence in daily life. The initial publication of the Missouri Autism Guidelines Initiative, Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment ( presents current best practice in screening, diagnostic evaluation, and assessment for intervention planning for individuals with ASDs. This Guide is a companion publication that begins where the initial document left off with the importance of comprehensive assessment for intervention planning and describes the next steps in the intervention process including development and implementation of an intervention plan. Pathway to Improved Outcomes Figure 1.1 Screening Diagnosis Assessment for Intervention Planning Development and Implementation of Intervention Plan Improved Outcomes n Level of Independence n Health and Wellbeing n Quality of Life Figure 1.1 attempts to capture the dynamic nature of the process from screening to improved outcomes. Although the steps are depicted as occurring one after the other, the sequence of the steps varies based on individual needs and what providers are able to accomplish with available skills and resources. Development and implementation of an intervention plan is depicted as occurring after diagnosis, but it may begin earlier in the process. For example, when screening results are positive, children may be immediately referred for certain intervention services; in these cases, assessment, selection, and implementation of initial interventions may occur while plans are being made to conduct the diagnostic evaluation. Information from initial assessment and intervention can then inform the diagnostic process and future intervention decisions. guide to evidence-based interventions 3
12 Assisting persons with ASDs and their families to achieve positive outcomes is a continuous and ongoing process. Interventions for ASDs vary in scope, focus, purpose, intensity, duration, and methodology. They focus on improving social interaction and communication, addressing challenging behaviors, increasing educational engagement and achievement, treating commonly associated difficulties (e.g., anxiety), promoting independence, and improving quality of life. Intervention goals vary for different individuals and most individuals with ASDs receive a combination of interventions. Access to effective intervention is critical. Individuals with ASDs, their families, and professionals who care for persons with ASDs all want to use interventions that work. Over the past 5 years, several nationally recognized research groups have used systematic reviews to describe the available evidence on the effectiveness, benefits, and harms of different intervention options for individuals with ASDs. The methods used in these reviews differ and, as a result, the reviews differ to some extent in their findings. Yet an important message consistently emerges across all of the reviews: Although this is an evolving field, research evidence on the effectiveness of interventions for ASDs has shown promise. There are effective interventions that produce positive outcomes for persons with ASDs. To make the best decisions about intervention options for persons with ASDs, individuals with ASDs and their families, healthcare professionals, educators, and other service providers need up-to-date information about intervention choices. The six systematic research reviews summarized as a key part of this publication fill a need for this type of information (see Chapter Four). In addition, a list of 39 effective interventions has been developed by consensus of the Missouri Autism Guidelines Initiative to describe interventions ranked at the top level of research support by one or more of the systematic reviews summarized in this Guide. This list of interventions provides a synthesis of findings across reviews (see Chapter Three). It is not the intention of this document to recommend what interventions should or should not be used for a specific individual with an ASD. Instead, the document describes an evidence-based approach to intervention selection as part of an overall process that includes comprehensive assessment for intervention planning, development and implementation of an intervention plan, and progress monitoring. 4 autism spectrum disorders
13 Overview of Evidence-based Practice Evidence-based practice originated in the medical field, where thousands of carefully controlled research studies have been conducted. Dr. David Sackett, a pioneer in evidencebased practice, and his colleagues defined evidence-based medicine as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research (Sackett et al., 1996, 71-72). Similarly, the Institute of Medicine has defined evidence-based practice as the integration of best-researched evidence and clinical expertise with patient values (National Research Council, 2001). chapter 1 Disciplines such as psychology and education have embraced the evidence-based practice movement as a nationwide effort to build quality and accountability. The American Psychological Association has defined evidence-based practice as the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (APA, 2001). Definitions incorporated into state and federal laws and regulations also guide practice. For example, the regulations for the federal law which ensures that all children with disabilities have access to a free and appropriate public education (FAPE), the Individuals with Disabilities Education Act (IDEA), requires that educational strategies be based on scientifically based research. The regulations define scientifically based research as research that involves the application of rigorous, systematic, and objective procedures to obtain reliable and valid knowledge relevant to education activities and programs [20 U.S.C (e) (2) (C) (xi)]. Similarly, the National Center on Response to Intervention, a national technical assistance center for schools and school districts, defines evidence-based interventions as those for which data from scientific, rigorous research designs have demonstrated the efficacy of the intervention (National Center on Response to Intervention, 2010, p. 6). Although there is no universal definition of evidence-based practice, definitions from diverse areas of professional practice share the following core theme: Evidence-based practice requires careful assessment of current research with the goal of identifying interventions that have demonstrated effectiveness. n The quality of research studies must be assessed, as this varies from study to study. n More than one study by more than one research group must show the same outcome to ensure confidence in the results. n Evidence must be considered in the context of professional expertise and individual characteristics. guide to evidence-based interventions 5
14 Evidence-based Practice as a Framework for ASD Intervention Individuals with ASDs, their families, and providers all want to select interventions that result in improved outcomes. This Guide presents evidence-based practice as a framework for decision making that results in selection and implementation of interventions that are most likely to be effective in meeting the goals of a specific individual with an ASD. Evidence-based practice includes consideration of the best available research evidence in the context of individual characteristics and professional expertise (see Figure 1.2). Evidence-based practice Figure 1.2 Professional Expertise Individual Characteristics Evidencebased practice Best Available Research Chapter Two describes an evidence-based approach to intervention selection as part of a three-step intervention process that includes assessment for intervention planning, development and implementation of an intervention plan, and progress monitoring. Following assessment to identify the individual s strengths and needs, families and providers work together to review interventions with a high level of research support that fit with individual intervention goals and other individual characteristics. Intervention selection includes consideration of individual and family values and preferences, as well as available family and community resources. Professional expertise plays a critical role in interpreting and applying research findings during intervention selection and informs decision making throughout the intervention process. 6 autism spectrum disorders
15 chapter 1 Systematic Reviews Provide the Best Available Research to Support Evidence-based Practice Evidence-based practice is not uniformly applied in all areas of professional practice or by all professionals in any given discipline. Some professionals contact trusted colleagues who are familiar with the research literature for suggestions regarding effective interventions. Others use interventions with which they have extensive experience in improving outcomes. Two other approaches to evidence-based practice have been described (Dijkers, 2008). In the first approach, a professional who is faced with a decision regarding which intervention to use searches the literature, reviews abstracts to identify relevant studies, retrieves copies of these studies, synthesizes their findings, and integrates this information with his or her professional experience and the characteristics of the person with an ASD to select the intervention. In the second approach, professionals turn to systematic reviews to guide their decision making. This Guide presents systematic reviews as the best available research evidence to support evidence-based practice. Systematic reviews are developed by groups of researchers who collaborate to systematically search for, evaluate, and synthesize all relevant studies on a specific topic. Combining studies mathematically provides more precise information about the results of an intervention (e.g., effect size) and addresses any differences in research results. All systematic reviews use a hierarchy of research designs to sort the stronger evidence from the weaker. In their recommendations, the authors of systematic reviews take into account the quality, quantity, and consistency of the evidence. Although the systematic reviews provide summaries of the best available research evidence, members of the Missouri Autism Guidelines Initiative recognize the limitations of these reviews. For example, many systematic reviews have used such strict standards for evaluating research evidence that very few studies qualify for consideration; as a result, very few interventions are considered effective and the need for more research becomes the main finding of the review. Such highly technical decisions about research methodology can result in significant real world consequences related to individual access to intervention services. Therefore, this Guide acknowledges the limitations of currently available research including findings from systematic reviews and emphasizes that research evidence is only one component of evidence-based practice. As described above, the best available research evidence is considered in the context of informed professional judgment and individual characteristics. Intervention decisions include consideration of each individual s unique presentation including specific strengths and needs, individual and family values and preferences, and available family and community resources. guide to evidence-based interventions 7
16 Research Reviews that Inform This Guide Six nationally recognized systematic reviews of ASD interventions have been selected by the Missouri Autism Guidelines Initiative as the focus of this Guide. These reviews were sponsored by federal government agencies, nationally recognized nonprofit organizations with expertise in developmental disabilities, or nationally recognized academic institutions. Together, they provide up-to-date information on the effectiveness of a broad array of ASD interventions that include behavioral, educational, medical, allied health, and complementary and alternative interventions. The research reviews are listed in Table 1.1. The table includes abbreviations for the review s sponsoring organization (in bold) as well as the full citation for the published review to assist in its retrieval. An overview of the reviews is presented in Chapter Three on pages 60 and 61. It provides a side-by-side comparison of the reviews in terms of focus, age range, number of studies reviewed, dates of research reviewed, and classification systems to rank effectiveness. Systematic Reviews Presented in this Guide table 1.1 Sponsoring abbreviation Organization Used in Guide Full Citation(s) National Professional Development Center on Autism Spectrum Disorders NPDC U.S. Department of Education Office of Special Education Programs, National Professional Development Center on Autism Spectrum Disorders. (2010). Evidence-based practices for children and youth with ASD. Retrieved from evidence-based-practices Odom, S. L., Collet-Klingenberg, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure, 54(4), Available from Centers for Medicare and Medicaid Services (Prepared by IMPAQ) National Autism Center Agency for Healthcare Research and Quality (Prepared by Vanderbilt Evidencebased Practice Center) CMS NSP AHRQ Young, J., Corea, C., Kimani, J., & Mandell, D. (2010). Autism spectrum disorders (ASDs) services: Final report on environmental scan (pp. 1-59). Columbia, MD: IMPAQ International. Retrieved from project-reports/finalasdreport.pdf National Autism Center. (2009). National standards report: The national standards project Addressing the need for evidence-based practice guidelines for autism spectrum disorders. Retrieved from pdf Warren, Z., Veenstra-VanderWeele, J., Stone, W., Bruzek, J. L., Nahmias, A. S., Foss-Feig, J. H., McPheeters, M. (2011). Therapies for children with autism spectrum disorders. Comparative Effectiveness Review Number 26. AHRQ Publication No. 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from /656/CER26_Autism_Report_ pdf 8 autism spectrum disorders (continued)
17 (continued) chapter 1 Systematic Reviews Presented in this Guide table 1.1 Sponsoring abbreviation Organization Used in Guide Full Citation(s) Stanford Autism Research Team StART Huffman, L. C., Sutcliffe, T. L., Tanner, I. S. D., & Feldman, H. M. (2011). Management of symptoms in children with autism spectrum disorders: A comprehensive review of pharmacologic and complementary-alternative medicine treatments. Journal of Developmental and Behavioral Pediatrics, 32, Available from Evaluation of Comprehensive Treatment Models for Individuals with Autism Spectrum Disorders CTM Odom, S. L., Boyd, B. A., Hall, L. J., & Hume, K. (2010). Evaluation of comprehensive treatment models for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 40, Retrieved from admin/assets/docs/aba_ pdf This Guide presents data from the six systematic reviews in multiple formats. The citations for the research reviews are listed above and integrated in several places throughout the document for individuals who wish to refer to or read the original publications. Summaries of each of the six reviews are provided in Chapter Four for readers interested in a more concise description of the objectives, methods, and results of each review. Chapter Three synthesizes the research findings across the six reviews and highlights 39 effective interventions identified by consensus of the Initiative based on the interventions ranking at the top level of research support by one or more of the systematic reviews. Core Values of the Missouri Autism Guidelines Initiative In addition to emphasizing evidence-based practice, the current Guide continues to reflect several core values initially introduced in the Initiative s companion publication, Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment. Family-centered Care For most clinical and community-based services, the needs, priorities, and resources of the individual with an ASD and his/her family are understood to be the primary focus and are respectfully considered throughout the intervention process. A family-centered frame of reference includes cultural sensitivity and regard for diversity of cultural values, language, religion, education, socio-economic, and social-emotional factors. Providers listen to the concerns, values, and goals of the individual and his/her family. Families are treated as equal partners and are encouraged to play an active role in selecting and implementing interventions and monitoring their effectiveness. Providers collaborate with individuals with ASDs and their families throughout the intervention process. Evidence-based practice includes an emphasis on family-centered care; intervention selection involves consideration of individual characteristics including family values and preferences, as well as family resources. guide to evidence-based interventions 9
18 10 autism spectrum disorders In contrast to the focus of clinical and community-based services, the primary focus of the public education system is defined by federal legislation as providing students (ages 3 years and above) with access to a free and appropriate public education (FAPE). Decisions regarding eligibility for services, individual goals, and intervention selection are made by an educational team of which the student with an ASD (as appropriate) and his/her family are important members. Early Intervention and Ongoing Supports The weight of the evidence indicates that early identification and early intervention can maximize the progress of children with ASDs. In addition, individuals with ASDs benefit from ongoing access to intervention services to address needs that arise over the course of their development. When a diagnosis is made or additional needs are identified at a later age, older children, adolescents, and adults can continue to benefit from appropriate intervention services. Therefore, intervention planning includes consideration of the need to start as early as possible and sustain needed interventions over the life span, with enhanced monitoring during times of developmental transition (e.g., from early childhood programs to public school, or from adolescence to adulthood). Informed Professional Judgment In the initial Initiative publication, informed professional judgment was presented as critical to best practice in screening, diagnosing, and assessing individuals with ASDs. The current Guide continues to emphasize informed professional judgment as a core ingredient of high quality ASD services and presents professional expertise as a component of evidence-based practice. During the intervention process, informed professional judgment plays a critical role in interpreting and applying research findings, tailoring interventions to match individual characteristics and needs, incorporating family values and preferences, considering available resources, implementing the plan, establishing appropriate goals and procedures for monitoring progress, and interpreting progress monitoring data. The Interdisciplinary Team Because of multiple developmental domains impacted by ASDs, the intervention process requires involvement of professionals representing multiple disciplines (e.g., primary and specialty physicians, nurses, psychologists, speech-language professionals, audiologists, occupational therapists, social workers, behavioral and educational specialists, applied behavior analysts, teachers, etc.). As shown in Figure 1.3, several service systems typically are involved in providing interventions including clinical, educational, and other communitybased services. Individuals with ASDs and their families are core members of the intervention team. Families work collaboratively within and across disciplines and systems of care to integrate the various services. One professional team member often takes responsibility to work closely with families to support their efforts to access comprehensive and coordinated care. Community Collaboration The concept of community collaboration is integrated throughout this document as a way to promote discussion among clinicians, educators, state programs, researchers, and families as they move toward improved service delivery for persons with ASDs. Consistent with national recommendations for ASD service delivery (Interagency Autism Coordinating Committee, 2005), the Guide promotes access to a range of high quality interventions through interdisciplinary and interagency collaboration with the referred individual and the family. As presented in the Initiative s companion publication, Missouri has adopted a framework for community collaboration that depicts an interwoven network promoting the best outcomes for persons with ASDs (see Figure 1.3). In addition to addressing ASD or disability-specific care, this framework acknowledges the individual s need to access other community and agency services while also taking into account the current social and environmental context such as state and federal laws, the availability of public and private health insurance, and cultural factors.
19 chapter 1 Community Collaboration Model Figure 1.3 n Public and Private Financing n Evidence-based Practice Guidelines n Professional Training n State and Federal Education and Disability Law n Public Health and Safety n Cultural Factors Social And Environmental Context Community and Agency Services n Diagnostic and Assessment Services n Specialized Medical Care n Specialized Behavioral Programs and Therapies n Social Competence Groups n Educational Consultation n Transition Services n Parent Training n Family Support Services ASD Services Primary Medical Home Individual with an ASD and Family n Regular and Special Education n Child Care and Respite Services n Community Mental Health Services n Community Health Clinics and Hospitals n State Agencies n Protection and Advocacy Services n Independent Living and Vocational Support Agencies n Residential Care n Family-to-Family Supports n Primary Care and Health Care n Developmental Screening n Care Coordination guide to evidence-based interventions 11
20 How to Use This Guide This Guide is intended as a companion publication to the initial work of the Missouri Autism Guidelines Initiative entitled Autism Spectrum Disorders: Missouri Best Practice Guidelines for Screening, Diagnosis, and Assessment. Together the two documents provide an up-to-date summary of the continuous and ongoing processes through which families and providers collaborate to improve outcomes for individuals with ASDs. This Guide has been developed for several audiences persons with ASDs and their families, healthcare professionals, educators, and other service providers. The Guide presents information in multiple formats and utilizes multiple devices to allow readers to access the information presented at a level of breadth, depth, and complexity that best meets their needs. Findings from the systematic reviews are presented in multiple formats ranging from a synthesis of findings in Chapter Three to more detailed summaries in Chapter Four to references for accessing the original publications. For that reason, there is some repetition of key concepts from chapter to chapter. However, consideration of the best available data is only one aspect of evidence-based practice, and intervention selection is only one component of the intervention process. To provide a more comprehensive understanding, Chapter Two describes the three steps in the intervention process and presents evidence-based practice as a framework for intervention selection during intervention plan development. Because the intervention process can vary across the multiple service delivery systems typically involved in ASD intervention, Chapter Two also presents more detail about the intervention process from the perspectives of families, medical and other healthcare professionals, educators, and other service providers. Case examples are presented to illustrate key ideas. The document also includes a comprehensive glossary, bibliography, and several appendices that reference documents and websites that may be useful in implementation of the ideas contained in the Guide. 12 autism spectrum disorders
Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines
Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Statewide Inpatient Psychiatric Program Services (SIPP) Statewide Inpatient PsychiatricMore information
Bullying Prevention and Autism Spectrum Disorders Objectives: Target Audience: Biography:
Bullying Prevention and Autism Spectrum Disorders Presenter: Scott Ross, Ph.D., BCBA-D This presentation will describe a functional approach to bullying prevention for all students, including those withMore information
College of Education. Rehabilitation Counseling
* 515 MEDICAL AND PSYCHOSOCIAL ASPECTS OF DISABILITIES I. (3) This course is designed to prepare rehabilitation and mental health counselors, social works and students in related fields with a workingMore information
Clarification of Medicaid Coverage of Services to Children with Autism
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-26-12 Baltimore, Maryland 21244-1850 CMCS Informational Bulletin DATE: July 7, 2014More information
Alabama Autism Task Force Preliminary Recommendations
Alabama Autism Task Force Preliminary Recommendations Having reviewed the findings to date from the Alabama Autism Collaborative Group (AACG), The Alabama Autism Task Force proposes the following changesMore information
Postdoctoral Fellowship in Clinical Psychology 2016 2017. Advanced training in cognitive behavioral treatment and applied behavior analysis
Postdoctoral Fellowship in Clinical Psychology 2016 2017 Advanced training in cognitive behavioral treatment and applied behavior analysis Excellence in service, training, and research is a critical elementMore information
Regence. Section: Mental Health Last Reviewed Date: January 2013. Policy No: 18 Effective Date: March 1, 2013
Regence Medical Policy Manual Topic: Applied Behavior Analysis for the Treatment of Autism Spectrum Disorders Date of Origin: January 2012 Section: Mental Health Last Reviewed Date: January 2013 PolicyMore information
Schmoga: Yoga-based self-regulation programming for children with Autism Spectrum Disorder in the school environment Kara Larson, OTD/S
Schmoga: Yoga-based self-regulation programming for children with Autism Spectrum Disorder in the school environment Kara Larson, OTD/S Faculty Advisors: Dr. Christine Manville, EdD, MEd, OTR/L Dr. TamaraMore information
Summary of Evidence Applied Behavior Analysis. Autism Technical Advisory Group 11/14/12
Summary of Evidence Applied Behavior Analysis Autism Technical Advisory Group 11/14/12 Outline Treatment targets and types Recent Evidence Reviews Recent Recommendations Summary Treatment Goals TreatmentMore information
Graduate Courses: Master s Courses (NURS) AY 2012-13 (Effective August 2012) Professional Core 646 HEALTH CARE POLICY IN THE U.S.: DEVELOPMENT, IMPACTS AND IMPLICATIONS FOR NURSES (3). This course examinesMore information
Tennessee Disability Pathfinder Statewide Autism Resources
Agency Name & Location Department of Education Family Support Program, DMRS State Office Support & Training for Exceptional Parents (S.T.E.P.) Tennessee Disability Pathfinder Tennessee Early InterventionMore information
ENTRY- LEVEL HEALTH PROFESSIONAL DEGREE Developed by the Partnership for Health in Aging Workgroup on Multidisciplinary Competencies in Geriatrics With Support from the American Geriatrics Society (AGS)More information
Autism Spectrum Disorder. Action Plan
Autism Spectrum Disorder Action Plan Autism Spectrum Disorder Action Plan CONTENTS Introduction and Background What is Autism Spectrum Disorder?... 2 What have we learned?... 2 What is the Action PlanMore information
... and. Uses data to help schools identify needs for prevention and intervention programs.
Rubric for Evaluating North Carolina s School Psychologists Standard 1: School psychologists demonstrate leadership. School psychologists demonstrate leadership by promoting and enhancing the overall academicMore information
Basis for Final Grade. Grading Scale (%) 96-100 Honors 69-95 Pass 0-68 Fail 30% 15% 20% 35% 100%
Interprofessional Study of Autism Spectrum Disorder (ASD) and Neurodevelopmental (ND) Disabilities 1 &2 A SC LEND Educational Program involving collaboration between: Medical University of South CarolinaMore information
Integrated Center for Child Development. Narrative
Integrated Center for Child Development Narrative The Integrated Center for Child Development (ICCD) is a multi-disciplinary center offering neuropsychological, behavioral, medical, and educational servicesMore information
Southeast Regional Autism Center. A Program of May Institute Affiliated with the National Autism Center
Southeast Regional Autism Center A Program of May Institute Affiliated with the National Autism Center Characterized by disorders in behavior, social interaction, and communication, autism can create enormousMore information
Applied Behavior Analysis for Autism Spectrum Disorders
Applied Behavior Analysis for Autism Spectrum Disorders I. Policy University Health Alliance (UHA) will reimburse for Applied Behavioral Analysis (ABA), as required in relevant State of Hawaii mandates,More information
Evidence for Effectiveness of ABA as a Treatment for Autism
Evidence for Effectiveness of ABA as a Treatment for Autism Introduction This document summarizes medical and scientific evidence for effectiveness of applied behavior analysis (ABA) as a treatment forMore information
American Society of Addiction Medicine
American Society of Addiction Medicine Public Policy Statement on Treatment for Alcohol and Other Drug Addiction 1 I. General Definitions of Addiction Treatment Addiction Treatment is the use of any planned,More information
Provider Qualifications
Provider Qualifications The following establishes general qualifications for providers by type of service. Additional qualifications may need to be met depending on the program and related funding sourceMore information
STANDARDS OF PRACTICE FOR PRACTITIONERS OF BEHAVIOUR ANALYSIS IN ONTARIO 2010 Revision
STANDARDS OF PRACTICE FOR PRACTITIONERS OF BEHAVIOUR ANALYSIS IN ONTARIO 2010 Revision Revision of Standards developed and approved by ONTABA Board of Directors 2010: Darryl Nurse-President, Jennifer Porter-PresidentMore information
The Patient Protection & Affordable Care Act: Proposed Action Steps For School Psychologists
The Patient Protection & Affordable Care Act: Proposed Action Steps For School Psychologists Background about the Patient Protection and Affordable Care Act (ACA) The Supreme Court decision in 2012 upholdingMore information
Applied Behavior Analysis (ABA)
MEDICAL POLICY POLICY RELATED POLICIES POLICY GUIDELINES DESCRIPTION SCOPE BENEFIT APPLICATION RATIONALE REFERENCES CODING APPENDIX HISTORY Applied Behavior Analysis (ABA) Number 3.01.510 Effective DateMore information
P r o f e s s i o n a l P s y c h o l o g y
D o c t o r a l I n t e r n s h i p T r a i n i n g i n P r o f e s s i o n a l P s y c h o l o g y K e n n e d y K r i e g e r I n s t i t u t e Johns Hopkins University School of Medicine B a l t i mMore information
Perkins Cancellation
FEDERAL STUDENT AID HANDBOOK Volume 6 Managing Campus-Based Programs, 2011 2012 http://ifap.ed.gov/fsahandbook/attachments/1112fsahbkvol6ch5.pdf THIS IS AN EXCERPT FROM VOLUME 6, CHAPTER 5 CHAPTER 5 PerkinsMore information
TENNCARE MEDICAL NECESSITY GUIDELINES Procedure: Applied Behavioral Analysis Page 2 of 5
Procedure: Applied Behavioral Analysis Origin Date: 1/10/2006, Revised 01/27/ 2015 Approved by: Vaughn Frigon, M.D. Page 1 of 5 Applied Behavioral Analysis Medical Necessity Guidelines I. Description ofMore information
Appendix Health Service Psychology: Preparing Competent Practitioners
Appendix Health Service Psychology: Preparing Competent Practitioners This document is copyrighted by the American Psychological Association or one of its allied publishers. Advances in psychological scienceMore information
Target Audience: Special Education Teachers, Related Service Providers, School Psychologists.
The Power Card Strategy: Using Special Interest to Teach Social and Behavior Expectations Presenter: Elisa Gagnon, MS.Ed. This training introduces the use of the Power Card Strategy to motivate studentsMore information
Behavioral Consultants:
Behavioral Consultants: Who Are They and How Do I Find the Right One? What is a Behavioral Consultant and How is This Different From a Psychologist? These questions are often asked by people trying toMore information
Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management
Autism Spectrum Disorder: ABA Services Delivery Model for Medicaid & PEBB Gail Kreiger, BSN Manager, Healthcare Benefits and Utilization Management Health Care Services May 2, 2013 What: A benefit forMore information
Title: Proposition to Establish a Graduate Certificate Program in Autism Spectrum Disorders (ASD) 4/3/2014 - unanimous
Proposition: 04-14/15 Title: Proposition to Establish a Graduate Certificate Program in Autism Spectrum Disorders (ASD) Proposition Sponsors: Linda Spencer (College of Education) Proposed Committee: AcademicMore information
US Behavior Analyst Workforce: Understanding the National Demand for Behavior Analysts
US Behavior Analyst Workforce: Understanding the National Demand for Behavior Analysts Produced by Burning Glass Technologies on behalf of the Behavior Analyst Certification Board. Electronic and/or paperMore information
MEDICAID SERVICES MANUAL TRANSMITTAL LETTER October 19, 2015 TO: FROM: SUBJECT: CUSTODIANS OF MEDICAID SERVICES MANUAL TAMMY MOFFITT, CHIEF OF PROGRAM INTEGRITY MEDICAID SERVICES MANUAL CHANGES CHAPTERMore information
Health Resources and Services Administration Autism Spectrum Disorder Activities
Health Resources and Services Administration Autism Spectrum Disorder Activities Through the Combating Autism Act, HRSA s Maternal and Child Health Bureau (MCHB) funded coordinated investments to enableMore information
MEDICAL POLICY SUBJECT: APPLIED BEHAVIOR ANALYSIS FOR PAGE: 1 OF: 7 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product coversMore information
How to Use. The Treatment of Depression in Older Adults Evidence-Based Practices KITs. The Treatment of Depression in Older Adults
How to Use The Treatment of Depression in Older Adults Evidence-Based Practices KITs The Treatment of Depression in Older Adults How to Use The Treatment of Depression in Older Adults Evidence-Based PracticesMore information
APPLIED BEHAVIOR ANALYSIS MEDICAL NECESSITY GUIDE te: If there is a discrepancy between this guideline and a member's plan of benefits, the benefits plan will govern. In addition, coverage (and coverageMore information
University of South Florida OCD, Anxiety, and Related Disorders Behavioral Treatment Program
OCD and Related Disorders Clinic Profile University of South Florida OCD, Anxiety, and Related Disorders Behavioral Treatment Program Clinic/Program Director: Adam B. Lewin, PhD, ABPP Name of Intake Coordinator:More information
RtI Response to Intervention
DRAFT RtI Response to Intervention A Problem-Solving Approach to Student Success Guide Document TABLE OF CONTENTS Introduction... 1 Four Essential Components of RtI... 2 Component 1... 3 Component 2...More information
ATAM Brief: Highlights and Text of the New Minnesota Autism Laws Passed by the Legislature in 2013
ATAM Brief: Highlights and Text of the New Minnesota Autism Laws Passed by the Legislature in 2013 Reference: HF 1233 Health and Human Services Omnibus Bill Article 7, Sec. 14. [256B.0949] AUTISM EARLYMore information
Rubric for Evaluating North Carolina s Speech- Language Pathologists
Rubric for Evaluating North Carolina s Speech- Language Pathologists STANDARD 1: School speech-language pathologists demonstrate leadership, advocacy, collaboration, and ethical practices. School Speech-LanguageMore information
Program on Child Development and Preventive Care
Annual Report 2007 Program on Child Development and Preventive Care Children s success in school and later in life depends on their early experiences and the ability of their parents and caretakers toMore information
State of California Health and Human Services Agency Department of Health Care Services
State of California Health and Human Services Agency Department of Health Care Services TOBY DOUGLAS DIRECTOR EDMUND G. BROWN JR. GOVERNOR DATE: All Plan Letter 14-xxx TO: ALL MEDI-CAL MANAGED CARE HEALTHMore information
Integrated Delivery of Rehabilitation Services:
Integrated Delivery of Rehabilitation Services: Guidelines SPECIAL for NEEDS Children s STRATEGY Community Agencies, Health Guidelines Service for Providers Local Implementation and District School ofMore information
VCU 1 DEPARTMENT OF SPECIAL EDUCATION AND DISABILITY POLICY Colleen Thoma, Ph.D. Professor and chair The mission of the Department of Special Education and Disability Policy is to prepare skilled, effectiveMore information
2015-2016 Academic Catalog
2015-2016 Academic Catalog Autism Behavioral Studies Professors: Kuykendall, Rowe, Director Assistant Professors: Fetherston, Mitchell, Sharma, Sullivan Bachelor of Science in Autism Behavioral StudiesMore information
Doctoral Internship Program in Clinical Psychology 2015 2016. Advanced training in behavioral psychology and applied behavior analysis
Doctoral Internship Program in Clinical Psychology 2015 2016 Advanced training in behavioral psychology and applied behavior analysis c o n t e n t s Program and Clinical Philosophy Training Model 2 GoalsMore information
I. CHILD AND ADOLESCENT PSYCHIATRY PATIENT CORE COMPETENCIES. A. GENERAL: Child and adolescent psychiatrists shall demonstrate the following abilities: 1. To perform and document a relevant history andMore information
Evidence Based Approaches to Addiction and Mental Illness Treatment for Adults
Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.More information
Choosing Adoption Therapist
Choosing Adoption Therapist How do I find a therapist who is qualified with adoption and foster care issues? Selecting a therapist who understands adoption and foster care can be an important componentMore information
CHANGING THE EDUCATIONAL LANDSCAPE COLLEGE OF EDUCATION We are interested in creating new knowledge, but we don t conduct research just to collect data. We apply those findings directly in the schools.More information
POSITION: Speech Language Pathologist
Please note: This job description is one of several adopted by the State Board of Education between 1984 and 1987 and was designed to correspond with the evaluation instrument. Local school systems canMore information
Applied Behavioral Analysis Therapy (ABA)
Applied Behavioral Analysis Therapy (ABA) For all Group Health plans with a benefit (except Microsoft) ABA requires preauthorization for initial and continued therapy. Specific coverage may be definedMore information
Re: SPAs 15-004, 15-005, and 15-010: Services to Treat Autism Spectrum Disorders Pursuant to EPSDT
January 31, 2015 Ginny Mahoney Department of Social Services Medical Policy Unit 55 Farmington Avenue, 9th Floor Hartford, CT 06105 Email: email@example.com Re: SPAs 15-004, 15-005, and 15-010: ServicesMore information
ValueOptions Autism Care Management Product. Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer
ValueOptions Autism Care Management Product Bryan Davey, PhD, BCBA-D Christopher Dennis, MD, MBA, ValueOptions Chief Medical Officer Autism Spectrum Disorders Background 2 Autism Spectrum Disorders withinMore information
Nurse Practitioner Student Learning Outcomes
ADULT-GERONTOLOGY PRIMARY CARE NURSE PRACTITIONER Nurse Practitioner Student Learning Outcomes Students in the Nurse Practitioner Program at Wilkes University will: 1. Synthesize theoretical, scientific,More information
Introduction and Invitation for Public Comment
2 of 22 Introduction and Invitation for Public Comment The Patient-Centered Outcomes Research Institute (PCORI) is an independent, non-profit health research organization. Its mission is to fund researchMore information
Billing Frequently Asked Questions
Billing Frequently Asked Questions What are the general conditions which must be met in order to bill for a service? All billed services except assessment must be medically necessary for the treatmentMore information
Mental Health Services for Children and Youth in Nova Scotia
Mental Health Services for Children and Youth in Nova Scotia Presentation to the Standing Committee on Community Services - June 1, 2010 Patricia Murray, Director of Children s Services Mental Health,More information
University of North Carolina TEACCH Autism Program Professional Certification
University of North Carolina TEACCH Autism Program Professional Certification INTRODUCTION AND RATIONALE The University of North Carolina TEACCH Autism Program was established in 1972 to serve as a statewideMore information
Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder
Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Policy Number: Original Effective Date: MM.12.022 01/01/2016 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST IntegrationMore information
Children and Families Commission 714-834-5186 (office) 714-390-9567 (Cell) 949-824-6455
FOR IMMEDIATE RELEASE December 13, 2012 CONTACT: Kelly Pijl Tom Vasich Children and Families Commission UC Irvine 714-834-5186 (office) 714-390-9567 (Cell) 949-824-6455 firstname.lastname@example.com firstname.lastname@example.com information
Testimony on New Jersey s Maternal and Child Health Services Title V Block Grant 2016 Application
Testimony on New Jersey s Maternal and Child Health Services Title V Block Grant 2016 Application On Behalf of The Boggs Center on Developmental Disabilities New Jersey s University Center for ExcellenceMore information
ARLINGTON PUBLIC SCHOOLS SPECIAL EDUCATION PROGRAMS AND SERVICES Introduction The Arlington Public Schools provides a comprehensive array of programs and services from pre-school through grades 12 designedMore information
THE FRAMEWORK FOR AUTISM SPECTRUM DISORDERS PROGRAM ENDORSEMENT GUIDELINES PENNSYLVANIA DEPARTMENT OF EDUCATION TABLE OF CONTENTS Definition of an Endorsement Certificate...3 Introduction to Autism SpectrumMore information
Autism Speaks Grant Report 2012-2013. Title of Project: Educating for Excellence: Training Paraprofessionals in ASD Best Practices
Autism Speaks Grant Report 2012-2013 Title of Project: Educating for Excellence: Training Paraprofessionals in ASD Best Practices Grant Recipient: The Autism Project 1516 Atwood Ave., Johnston, RI 02919More information
Graduate Program Objective #1 Course Objectives
1 Graduate Program Objective #1: Integrate nursing science and theory, biophysical, psychosocial, ethical, analytical, and organizational science as the foundation for the highest level of nursing practice.More information
VCU 1 SPECIAL EDUCATION AND DISABILITY POLICY (SEDP) SEDP 330. Survey of Special Education. 3 Semester course; 3 lecture hours. 3 credits. Presents an overview of the historical basis and regulatory requirementsMore information
III. FREE APPROPRIATE PUBLIC EDUCATION (FAPE) Understanding what the law requires in terms of providing a free appropriate public education to students with disabilities is central to understanding theMore information
COMPARATIVE EFFECTIVENESS RESEARCH (CER) AND SOCIAL WORK: STRENGTHENING THE CONNECTION EXECUTIVE SUMMARY FROM THE NOVEMBER 16, 2009 SWPI INAUGURAL SYMPOSIUM For a copy of the full report Comparative EffectivenessMore information
Second Year Fall. Spring
Occupational Therapy Program Curriculum (3+3 Students = OTFY courses; first year only.) Please note, course descriptions are updated periodically. First Year Fall Credits GMOT 6110/OTFY 4110 FunctionalMore information
Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder
Applied Behavior Analysis Therapy for Treatment of Autism Spectrum Disorder Policy Number: Original Effective Date: MM.12.022 01/01/2016 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST IntegrationMore information
HPNA Position Statement Evidence-Based Practice
HPNA Position Statement Evidence-Based Practice Background Increased attention is being directed toward the development of methods that can provide valid and reliable information about what works bestMore information
Medicare Program; Conditions of Participation (CoPs) for Community Mental Health Centers.
Donald M. Berwick, MD Administrator, Centers for Medicare & Medicaid Services Department of Health and Human Services PO Box 8010 Baltimore, MD 21244-1850 Attention: CMS 3202-P Submitted electronicallyMore information
The Department of Vermont Health Access Medical Policy
State of Vermont Department of Vermont Health Access 312 Hurricane Lane, Suite 201 [Phone] 802-879-5903 Williston, VT 05495-2807 [Fax] 802-879-5963 www.dvha.vermont.gov Agency of Human Services The DepartmentMore information
Competence, Capacity, and Collaboration
Competence, Capacity, and Collaboration OSPA 2015 Fall Conference Speaker Directory October 8th and 9 th Eugene, OR Speaker Biographies Gena P. Barnhill, PhD., NCSP, BCBA- D, LBA Building CollaborativeMore information
H.R 2646 Summary and S. 1945 Comparison
H.R 2646 Summary and S. 1945 Comparison TITLE I ASSISTANT SECRETARY FOR MENTAL HEALTH AND SUBSTANCE USE DISORDERS It establishes an Office of the Assistant Secretary for Mental Health and Substance UseMore information
FAQs on Billing for Health and Behavior Services
FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from MedicareMore information
Mental Health Emergency Service Interventions for Children, Youth and Families
State of Rhode Island Department of Children, Youth and Families Mental Health Emergency Service Interventions for Children, Youth and Families Regulations for Certification May 16, 2012 I. GENERAL PROVISIONSMore information
Medicaid Health Homes Emerging Models and Implications for Solutions to Chronic Homelessness
Medicaid Health Homes Emerging Models and Implications for Solutions to Chronic Homelessness November 2012 Several states have begun implementing the new Medicaid health home benefit created by the AffordableMore information
1 The following is adapted from Division of Mental Retardation Services, State of Tennessee, Provider Manual,
Procedure: Applied Behavioral Analysis Origin Date: 01/10/06 / Revised 07/08/09 Approved by Wendy Long, M.D. Page 1 of 5 Applied Behavioral Analysis Medical Necessity Guidelines I. Description of ServiceMore information
Scope and Standards of Practice for The Acute Care Nurse Practitioner. American Association of Critical-Care Nurses
Scope and Standards of Practice for The Acute Care Nurse Practitioner American Association of Critical-Care Nurses Editor: Linda Bell, RN MSN Copy Editor: Anne Bernard Designer: Derek Bennett An AACN CriticalMore information
Can Licensed Mental Health Counselors Administer and Interpret Psychological Tests?
Can Licensed Mental Health Counselors Administer and Interpret Psychological Tests? ANALYSIS AND POSITION PAPER BY THE NATIONAL BOARD OF FORENSIC EVALUATORS The National Board of Forensic Evaluators (NBFE)More information
Page 1 of 9 ACTION: New : Effective Date: 03/01/2013 Revising : Review Dates: 12/4/2015 Superseding : Archiving : Retiring : Johns Hopkins HealthCare (JHHC) provides a full spectrum of health care productsMore information
STATE ALZHEIMER S DISEASE PLANS: CARE AND CASE MANAGEMENT Recommendations to improve the individual health care that those with Alzheimer s disease receive Arkansas California Colorado Illinois Iowa CommissionMore information
Accountable Care Organizations: Evidence is Essential for Success
Accountable Care Organizations: Evidence is Essential for Success Susan A. Levine, DVM, PhD Senior Vice President, Health Technology Research and Consulting Winifred S. Hayes, PhD President and CEO 157More information
TUSKEGEE UNIVERSITY College of Veterinary Medicine, Nursing and Allied Health School of Nursing and Allied Health. Occupational Therapy Program
TUSKEGEE UNIVERSITY College of Veterinary Medicine, Nursing and Allied Health School of Nursing and Allied Health Occupational Therapy Program Student Success for Health Science Majors Course Number: HLSCMore information
MILLIKIN TEACHING STANDARDS Millikin Teaching Standards are correlated to and modifications of Illinois Professional Teaching Standards. Modifications reflect Millikin s mission and the education unitMore information
Purpose. Admission Requirements NURSING EDUCATION STUDENT LEARNING OUTCOMES RESIDENCY REQUIREMENTS. Clinical Requirements
NURSING EDUCATION Purpose This program is designed for professional nurses who have earned a Master s or Doctoral Degree in Nursing and seek further education in advanced nursing practice. ConcentrationsMore information
An Overview of the Department of Assistive and Rehabilitative Services (DARS)
An Overview of the Department of Assistive and Rehabilitative Services (DARS) House Committee on Human Services Veronda L Durden, Commissioner February 16, 2015 Mission and Responsibilities Mission ToMore information
UC Davis MIND Institute ESDM Training Program
CERTIFICATION PROGRAM The following pages provide both an overview and detailed descriptions of the various levels of training available in the ESDM model. Each section is intended to be utilized as aMore information
International Academy of Life Care Planners Standards of Practice
International Academy of Life Care Planners Standards of Practice 2009 by International Association of Rehabilitation Professionals All rights reserved No part may be reproduced in any form or by any meansMore information
The Division of Health Care Financing and Policy
The Division of Health Care Financing and Policy Applied Behavior Analysis Presentation Shannon Sprout, SSPSIII Child and Adolescent Services Specialist Clinical Policy Unit, DHCFP 775-684-3732 firstname.lastname@example.com information
Expert Speaker Series for Behavior Analysts 2015-2016
Pennsylvania Expert Speaker Series for Behavior Analysts 2015-2016 Three BACB Type 2 Credits awarded to certificants per full presentation Events held in Melmark s Multi-Purpose Center Open to generalMore information
Page 1 of 9 ACTION: New : Effective Date: 03/01/2013 Revising : Review Dates: 12/4/2015 Superseding : Archiving : Retiring : Johns Hopkins HealthCare (JHHC) provides a full spectrum of health care productsMore information
Model for Comprehensive and Integrated School Psychological Services
Model for Comprehensive and Integrated School Psychological Services 2010 INTRODUCTION The mission of the National Association of School Psychologists (NASP) is to represent school psychology and supportMore information
Rubric : WI School Psychologist
Rubric : WI School Psychologist Diversity in Development and Learning Description: School psychologist has knowledge of individual differences, abilities, disabilities and other diverse student ; principlesMore information
Westminster Campus Nursing Program Curriculum Organizing Framework
Westminster Campus Nursing Program Curriculum Organizing Framework The curriculum organizing framework describes the concepts, beliefs and philosophy upon which the nursing curriculum is organized andMore information


text:
Solo Performance
Watercolour, imperial, Arches 300 pound not.
My first washes are applied to a fairly damp surface using warm colours, perhaps Raw and Burnt Sienna and a little Ultramarine and Alizarin, after the first washes are dry I switch to a limited palette for the bulk of the painting. I enjoy painting hens, but being honest the main reason is to introduce a small amount of Red into the painting.
Influences:- Philip Jamison and his book 'Capturing Nature in Watercolour' I believe that too much has been written about 'how to in watercolour' this American artist wrote one of the best, to prove the case try getting hold of a copy!

subset: commoncrawl


text:
Kent cigarettes were one of the sponsers of The Dick Van Dyke Show and would regularly hand out free cartons of Kents to the cast and crew. During an interview with David Letterman, Mary "confessed" that she didn't like Kents so she'd always take her share of the cartons and trade them in at the local store for her preferred brand.
In March of 1997, Mary Tyler Moore was supposed to be the master of ceremonies for the Directors Guild of America awards, but had to back out due to blurred vision caused by her diabetes.
Mary Tyler Moore has a twelve foot gate guarding her 30 acre estate in Millbrook, New York.
Mary Tyler Moore is a Roman Catholic.
Mary Tyler Moore won People's Choice Awards in 1976, 1977, 1978, and 1979 for "Favorite Female TV Performer."
In 1981, Mary Tyler Moore won a Golden Globe Award for "Best Actress in a Motion Picture" for the movie Ordinary People.
In 1984, Mary Tyler Moore won a Crystal Award for "Women in Film."
In 1993, Mary Tyler Moore won an Emmy for "Best Supporting Actress in a Miniseries or Special" for the tv movie Stolen Babies.
Mary Tyler Moore's name was mention in the song "Buddy Holly" by Weezer.
Mary Tyler Moore was the executive producer of the TV movie Like Mother, Like Son: The Strange Story of Sante and Kenny Gimes.
Mary Tyler Moore has appeared in over fifteen movies like The Blue Arrow, Ordinary People, Change of Habit, What's So Bad About Feeling Good?, Cheats, Labor Pains, and Flirting with Disaster.
Mary Tyler Moore is the a co-founder of Broadway Barks, which is an annual adopt-a-thon in New York City, New York.
Mary Tyler Moore has modeled secretly for the cover of several record albums.
Mary Tyler Moore went to Saint Rose of Lima Roman Catholic school in Brooklyn, New York.
Mary Tyler Moore has won seven Emmy Awards.
In 1980, Mary Tyler Moore was nominated for an Oscar for "Best Actress" for her role as Beth Jarrett in the movie Ordinary People.
Mary Tyler Moore is an accomplished dancer, producer, and actress.
In 1961, Mary Tyler Moore made her film debut in the movie X-15.
Mary Tyler Moore's autobiography After All, was released in 1996.
Mary Tyler Moore met her current husband, Dr. Robert Levine, when she had to take her ailing mother to the hospital.
In 1992, Mary Tyler Moore received her star on the Hollywood Walk of Fame.
The mascot for Mary Tyler Moore's production company MTM was an orange striped kitten named Mimsie.
In 1967, Mary Tyler Moore was supposed to appear in the Broadway play Holly Golightly, with Richard Chamberlain, but the producer cancelled the show because of the poor performances.
In 1996, Mary Tyler Moore was honored with the title "Queen of Brooklyn" during a "Welcome Back to Brooklyn Festival."
Mary Tyler Moore got breast implants in 1990, but had them removed in 1991.
In March of 2001, Mary Tyler Moore was the celebrity sponsor for the "Great American Meatout."
Mary Tyler Moore quit dancing and became an actor because dancing lack the spotlight that actors receive.
Mary Tyler Moore was married to Dick Meeker from 1955 until 1961. She then was married to Grant Tinker from 1962 until 1981. She married Dr Robert Levine in 1983, and as of 2006, they are still married.
In 2000, Mary Tyler Moore broke her wrist during the filming of Mary and Rhoda.
Mary Tyler Moore tried to help her brother end his life in an assisted suicide, but the attempt failed.
Mary Tyler Moore has seen a lot of death. Her sister Elizabeth, died from a drug overdose in 1978. Her brother died of cancer and her son, Richie, died from an accidental shooting in 1980.
Mary Tyler Moore is 5'8" tall.
Mary's character of Mary Richards from The Mary Tyler Moore Show was named number 8 on "Bravo's 100 Greatest TV Characters".
Mary's character from The Dick Van Dyke Show, Laura Petrie, was named number 78 on "Bravo's 100 Greatest TV Characters". She shares that rank with Dick Van Dyke's character, Rob Petrie.
In 1980, Mary won a special Tony Award for her performance in Whose Life is it Anyway?.
Mary has been a vegetarian for many years.
Mary Tyler Moore is the International Chairman for the Juvenile Diabetes Research Foundation International.
Mary has had five TV series after The Mary Tyler Moore Show, none of which was renewed for a second season.
Mary says she had a difficult childhood because of her mother's alcoholism.
In 1955, Mary got her first break in show business as the dancing kitchen appliance "Happy Hotpoint," the Hotpoint Appliance elf, in commercials which aired during the broadcast of the tv show The Adventures of Ozzie & Harriet.
Mary started dancing professionally within weeks of her graduating from high school.
While filming the 2000 reunion telefilm Mary and Rhoda with Valerie Harper, Mary broke a bone in her wrist.
There is only a 3 month age different between Mary Tyler Moore's son, Richie, and Mary's own sister, Elizabeth.
In 1984, Mary entered the Betty Ford Center for "social drinking habit".
Mary was diagnosed with Type 1 Diabetes, or insulin dependent diabetes, over 30 years ago.
Mary portrayed the first Sam, who was in charge of the answering service on CBS Television's 1957 series Richard Diamond, Private Detective. She was never seen on camera, only her legs were. She the show after only three months.
On May 8th 2002, a bronze statue capturing her character Mary Richard's signature hat-toss went on display May 8, 2002 at the Minneapolis intersection where the opening credits scene of The Mary Tyler Moore Show was filmed.
She was a heavy smoker during her time on The Dick Van Dyke Show, but has since quit.
Mary walked out of the Neil Simon play Rose's Dilemma in December 2003, citing problems with the playwright after he sent her an insulting note prior to an appearance regarding her failure to memorize lines.
In 1988, she appeared in the Broadway play Sweet Sue alongside actors Lynn Redgrave and Barry Tubb.
Mary co-founded MTM Enterprises in 1969 with her now ex-husband Grant Tinker. She sold the company in 1990.
In 2001, Mary Tyler Moore testified before Congress calling for an increase in funding for diabetes and to support embryonic stem cell research.
Mary is a strong animal rights activist.
Mary Tyler Moore: Pain nourishes courage. You can't be brave if you've only had wonderful things happen to you.
Mary Tyler Moore: I'm not an actress who can create a character. I play me.
Mary Tyler Moore: My hope is that all Americans will join in to help convince Congress to take that final step to fund research. In the end, it's all about realizing our interconnectedness, mutual compassion, and hope for the future.
Mary Tyler Moore: I was diagnosed with 'juvenile' or Type 1 diabetes over 30 years ago. It was initially terrifying, but as an adult, I was much better equipped to deal with this challenge than a young child.
Mary Tyler Moore: What most adults fail to remember, is that childhood is often filled with challenges, fears, and uncertainties as daunting as any we face decades later.
Mary Tyler Moore: (Talking about President George W. Bush's vetoing the Senate's bill supporting embryonic stem cell research) This is an intelligent human being with a heart, and I don't see how much longer he can deny those aspects of himself.
Mary Tyler Moore: (talking about fur) Behind every beautiful fur, there is a story. It is a bloody, barbaric story.
Mary Tyler Moore: Diabetes is an all-too-personal time bomb which can go off today, tomorrow, next year, or 10 years from now - a time bomb affecting millions like me and the children here today.
Mary Tyler Moore: There is a dark side. I tend not to be as optimistic as Mary Richards. I have an anger in me that I carry from my childhood experiences -- I expect a lot of myself and I'm not too kind to myself.
Mary Tyler Moore: Sometimes you have to get to know someone really well to realize you're really strangers.


text: Just watched the opening ceremonies of a Chicago Black Hawks hockey game in Edmonton. They sang the national anthems of both countries. The camera showed many views of the audience. All were standing, but NOBODY had their hand over their heart, including the American team members. As I understand it, this is definitely the etiquette in the US. Is Canada different? Just curious; I know we've got a bunch of Canucks hanging around here. /img/vbsmilies/smilies/wink.gif Mike /img/vbsmilies/smilies/confused.gif


text:
OSCAR DE LA HOYA FOUNDATION HOSTS 17th ANNUAL GOLF CLASSIC WITH CELEBRITY GUESTS TO RAISE THOUSANDS OF DOLLARS FOR YOUTH AND COMMUNITY PROGRAMSStory June 7, 2017
LOS ANGELES (June 5, 2017) The Oscar De La Hoya Foundation today hosted its 17th annual Golf Classic at the Lakeside Golf Club and raised thousands of dollars to help support programs that will benefit the youth and community of East Los Angeles.
Celebrities including Oscar De La Hoya, Adrian Gonzalez (Dodgers), Joe Mantegna (Criminal Minds, The Godfather III), Andy Garcia (The Godfather III, Ocean's Eleven), Richard Schiff (The West Wing), Steve Garvey (former Los Angeles Dodgers) and Eddie Sotelo (El Show de Piolin) all joined De La Hoya at Lakeside Golf Club for a day of fun competition on the green.
The Foundation annually hosts a boxing gym equipment donation, Thanksgiving dinner giveaway and holiday toy giveaway in addition to supporting the Oscar De La Hoy a Ánimo Charter High School, the Cecilia Gonzalez De La Hoya Cancer Center and the Oscar De La Hoya Labor and Delivery Center and Neonatal Intensive Care Unit (both located at White Memorial Hospital in East Los Angeles).
"Every year I am so thankful to our many guests and sponsors that support the Oscar De La Hoya Foundation Golf Classic and help us raise thousands of dollars to fund important programs and services that benefit the community of East Los Angeles," said Oscar De La Hoya, Chairman and CEO of Golden Boy Promotions.
The 17th Annual Oscar De La Hoya Foundation Golf Classic was sponsored by MGM Resorts International/AEG, Barry's Tickets, California Municipal Finance Authority,"Tecate, Born Bold," HBO Sports, World Boxing Organization, Alliance Radio Networks, National Funding, Inc., Adventist Health White Memorial, Clear Channel Communications, Fantasy Springs Resort Casino, Chapman, Bird & Tessler, ESPN, Merrill Lynch Private Banking & Investment Group, Key Code Media, Mercury Public Affairs and Andersen Tax.
About The Oscar De La Hoya Foundation:
In 1995, Oscar De La Hoya started his namesake Foundation to help improve the quality of life for the community in his hometown of East Los Angeles. Today, with the help many partners, the Foundation serves thousands of people annually. The Oscar De La Hoya Foundation supports the Oscar De La Hoya Ánimo Charter High School, the Cecilia Gonzalez De La Hoya Cancer Center and the Oscar De La Hoya Labor and Delivery Center and Neonatal Intensive Care Unit (both located at White Memorial Hospital in Los Angeles) as well as numerous after school programs that help guide young people toward leading positive lives and away from the circumstances of gang violence, juvenile delinquency and substance abuse.


text:
It is yet another shocking time in America (USA North /America). Skies have fallen, seas have risen, winter is beginning to push fall aside. Yet then there is another climate; politics, demanding that cloudy cover of lies, or select unspoken facts, are equivalent to facts in context. Politics makes opinion, supposition and interpretation its own climate. The truncated context that suits ideology that suits ignorance with its hands over ears and eyes becomes the TRUTH spoken as wisdom.
We have wishful thinking stalking our fears for signs of hope. Is this spring of desires promise really showing signs before winters cold digits seek out what warmth remains? How can this be?
H2 and O, Nitrogen and Carbon, parts of our chemical cocktail that fill the glass of Life. But what exactly are our ideas made of? We can deny the laws of Nature by pretending some other laws supersede, or better yet, deny the rules of Creations manifestation discerned by our sense and senses, inserting other ideas in their place, perhaps sanctified by calling them something? Divine?
Looking for proof of something through evidence beyond verifiable means, then pumping their "connections" up with emotional deregulation, opens the story of knowledge up to narration that can hide elements of deception. The tellers of the story then place these polluting particles behind flags or good books, for we no longer question human fallibilities that extend into the entire atmosphere of perception.
We do believe in science if we use electricity, food, water, shelter, for we have reasoned how to have nature nurture us by following its rules. Yes, its rules may be the rules of God as well, in fact likely more reliable as such than books selected by men mostly to run religion as they see fit.
We may wish our vote turns out for the best this election season, we will see. It is sometimes advised to be careful about our desires, for we may at times in life be shocked at the reality of what we wish for.
Upon a star…


text:
Audio Invite
We invite you to hear the recent sermons of Rev. Greg Meadows.
Audio Code for (Post)
Audio Code (Playlist)
Audio Directions
To listen to a sermon online Left mouse click the sermon title.
Simply click the title you desire to hear. NOTE: These are large files so they may take some time to load if you are listening directly on your PC or mobile device.
To download a sermon to your computer for listening at a later time or to play on an iPod or other MP3 player:
- Right mouse click on the sermon title. Left mouse click "Save Target As" or "Save Link As".
- Select where you want to save the file and Left mouse click "SAVE"


text:
Jawaharlal Nehru University Students' Union (JNUSU) leader Kanhaiya Kumar cannot be seen shouting anti-India slogans in a video that was used as a key evidence to slap sedition charges against him, the Delhi Police reportedly told the High Court on Monday.
The police said they have eyewitnesses to prove Kumar shouted slogans at an event organised Feb. 9 against the "judicial killing" of 2001 Parliament attack convict Afzal Guru. The video that was used to registered a case against Kumar was provided by a leading news channel.
"In the video Kanhaiya Kumar cannot be seen shouting slogans. However, there are witnesses to his shouting slogans... We do have independent witnesses — JNU officials, Chief security officers and students of JNU," ANI quoted the Delhi Police as saying to the court.
"Every witness said Kanhaiya was leading the mob, shouting the slogans," ANI, in a tweet, quoted special public prosecutor Shailendra Babbar as saying.
Senior advocate Kapil Sibal, who appeared for Kumar, told the court that the JNU president was at the sight of sloganeering to break a fight. "Kanhaiya was only there to break fight, he opposes anti national slogans &didn't raise them," he said.
Kanhaiya Kumar's lawyer Kapil Sibal to Delhi HC- Kanhaiya was only there to break fight, he opposes anti national slogans &didn't raise them
— ANI (@ANI_news) February 29, 2016
The court Monday heard Kumar's bail plea and reserved its order till March 2. High Court Justice Pratibha Rani rapped the Delhi Police and asked how Kumar can be held responsible if outsiders shouted anti-India slogans, the Hindu reports. The court also asked the police whether it even know what sedition is.
'Do you even know what sedition is?' Delhi High Court asks police during hearing on JNU student Kanhaiya Kumar's bail request — NDTV (@ndtv) February 29, 2016
Meanwhile, a Delhi court Monday extended JNU students Umar Khalid's and Anirban Bhattacharya's police custody for one more day. The Special Cell of Delhi Police, which is now interrogating the two students, sought some time to question them, Press Trust of India reports.
Both Khalid and Bhattacharya had disappeared from the campus Feb. 12, the day Kumar was arrested, but returned to campus Feb. 21 night and handed themselves to police on Feb. 24. They are also facing sedition charges for organising the event where anti-India slogans were allegedly shouted.


text: Hi, I am the dev behind this appplication (and others such as Pure calendar or Pure grid calendar). I'd like to concentrate here all informations about my widget. To contact me by mail : --- Pure messenger widget --- Show Gmail / SMS / Facebook / Twitter / POP3 / IMAP in one widget Features in : - show Gmail - show SMS - show Email from POP3 - show Email from IMAP - show Facebook - show Twitter (experimental) I need skins ... if you have any idea. I take. -------------------------------------------- Screenshots :


text:
Eye Heart SF & Mezzanine present the "Future Friday's 1 Year Anniversary" party! Featuring support from Above Ground Underground.
Friday, June 6th join us at Mezzanine for future sounds from SuperVision of Pretty Lights Music, Beni Haze, MANICS + special guests.
Over the past 12 months "Future Fridays" has showcased a very unique line up of talent including Jeremy Olander and FEHERPLAY, Keys N Krates, Dirty Vegas, TWRK, Proxy, Jacques Lu Cont, POSSO, Panic City, Myndset, and the infamous Daft Punk Tribute group ONE MORE TIME + many talented local artists.
Pre Sale Tickets - http://FutureFridayParty.com
VIP Bottle: email@example.com
• H O S T E D B A R • Yacht Club Vodka bar from 9p -10p
(while supplies last) + $5 Yacht Club cocktails all night


text:
STATE — With the 2013 Atlantic Hurricane Season set to officially begin tomorrow, state officials are reminding New Jersey residents to prepare by staying informed, making a family emergency plan and having a well-stocked emergency kit.
"The best time to prepare for an emergency is before it happens," said New Jersey Department of Health Commissioner Mary O'Dowd. "By taking time to make or review emergency plans and develop emergency kits, families can be ready for hurricane season or for any emergency. There are lessons learned from our experience with Superstorm Sandy, such as issues with generator safety, which can help improve our readiness and save lives."
New Jersey State Police Superintendent Colonel Rick Fuentes added, "Though hurricane season starts on June 1st and ends on November 30th, preparedness is a way of life. Preparedness means moving from 'lessons learned' to 'lessons applied,' in order to increase our state of readiness each and every year. The mission of the New Jersey Office of Emergency Management (NJOEM) is to build resilient communities, engage citizens in the emergency management process and make the process inclusive to all community members. Our goal is disaster survivors, not disaster victims."
Edward Dickson, Director of the New Jersey Office of Homeland Security and Preparedness (OHSP), said taking steps now to be better prepared for future emergencies will help save lives.
"With the start of the Atlantic hurricane season this weekend, we remain mindful of the damage and devastation caused by Irene and Sandy from the preceding hurricane seasons," Director Dickson said. "With this in mind, now is the best time to get prepared for this year's hurricane season and any possible storms."
New Jersey Department of Human Services Commissioner Jennifer Velez encouraged senior citizens and individuals with disabilities to work closely with their caregivers to secure an emergency plan for evacuation, medication and care in the event of a hurricane or any other type of emergency.
"It's important to have an emergency plan in place and one or two backup plans, particularly if caregiving services are involved," said Commissioner Velez. "In emergency situations, lack of electricity, phone service and transportation can significantly impact a person's ability to use medical devices or access food and pharmaceuticals."
Residents are encouraged to prepare by performing three tasks:
- Make an emergency plan. Make plans with family and friends in case you're not together when a hurricane or other emergencies occur. Discuss how you will contact each other, where you will meet and what you will do in different situations. Become familiar with your town's evacuation routes.
- Stay informed: Situations can change quickly during a public health emergency. Continue to monitor traditional media sources – TV, newspapers and radio – to stay informed of breaking news and continued coverage of emergency events. Find out if your community has a "reverse 9-1-1" system or if you can opt-in for email updates from municipal officials.
- Make an emergency kit: Emergency kits will allow individuals and families to survive several days without access to food, water or electricity. Emergency kits should include at least a three to five day supply of non-perishable food and water, prescription medications for up to two weeks if available, baby supplies and any additional items for special medical needs such as an extra pair of eye glasses and batteries for hearing aids. Your kit should also include important phone numbers for doctors as well as car cell-phone chargers.
In addition, if there is a power outage, residents considering using emergency generators should strictly follow manufacturer's recommendations and guidelines. If residents have questions about the operation or installation of a generator, they should call a licensed electrician.
Residents should never use a generator, grill, camp stove or other gasoline, propane, natural gas or charcoal burning device inside their home, basement, garage or even outside near an open window. The use of these devices can cause dangerous levels of carbon monoxide (CO) to build in a home.
Carbon monoxide is an odorless, colorless gas that can cause sudden illness or even death. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain and confusion.
For a comprehensive list of how to put a family emergency kit together, visit http://nj.gov/health/er/documents/kit.pdf.
The NJOEM recommends the following ways to stay informed about emergencies:
On the Web – Use credible websites to get information about natural hazards and emergency preparedness. The NJOEM works closely with the National Weather Service and the National Hurricane Center regarding storm predictions and forecasts.
National Weather Service – www.erh.noaa.gov/er/phi/
National Hurricane Center – www.nhc.noaa.gov/
NJ OEM – www.ready.nj.gov
ReadyNJ Alerts & Updates Blog: readynj.wordpress.com
NJ Department of Health (DOH): www.state.nj.us/health/er/hurricane.shtml
NJ OHSP: www.njhomelandsecurity.gov
Centers for Disease Control and Prevention (CDC) Hurricane Preparedness: http://www.emergency.cdc.gov/disasters/hurricanes
Federal Emergency Management Agency: www.fema.gov/index.shtm.
Social Media – Social media and other advanced communications technologies are used by the OEM and by emergency managers statewide.
NJDOH on Twitter: www.twitter.com/NJDHSS
NJOEM on Facebook: www.facebook.com/READYNEWJERSEY
NJOEM on Twitter: www.twitter.com/NJOEM2010
NJ State Police on Facebook: www.facebook.com/NewJerseyStatePolice
NJ State Police on Twitter: www.twitter.com/NJSP
Alerts – Mobile / Text (SMS) & E-Mail
- NIXLE – Subscribe to the NJ State Police (NJSP) on Nixle Connect at http://local.nixle.com/new-jersey-state-police/. New Jersey residents can register to receive messages by sending a text message with their zip code to 888777 (data rates may apply depending on your plan). Online registration is also available at www.nixle.com
- NJ Alert – NJ Alert is a free, voluntary and confidential emergency alerting system that allows NJ Office of Emergency Management officials to send E-mail or text messages to cell phones, and other email enabled devices during an emergency event. Sign up for NJ Alert by logging on to: www.njalert.gov.
- CMAS – the Community Mobile Alert System – the National Weather Service uses CMAS to transmit weather warnings. A cell phone must be WEA (Wireless Emergency Alert) enabled to receive these messages, check the make/model of your phone. Read about WEA alerts here: http://www.erh.noaa.gov/lwx/WEA/WEA.php
NOAA Weather Radio – is a nationwide network of radio stations broadcasting continuous weather information directly from the nearest National Weather Service Office. NOAA Weather Radio broadcasts official Weather Service warnings, watches, forecasts and other hazard information 24 hours a day, 7 days a week. NOAA Weather Radios are typically inexpensive, readily available in stores and can often be programmed for your specific area. http://www.nws.noaa.gov/nwr/
Connect with NJTODAY.NET
Join NJTODAY.NET's free Email List to receive occasional updates delivered right to your email address!


text:
Ruben of Cumagascas, an Inspiring Story
"I thought my life would suddenly improve after the land was awarded to me in 1997. I learned later that patience, persistence and improvisation were still needed after my initial failures in my attempts to increase production."- Ruben
Ruben Ragas, 43 years old, a native of Sanghan, Cabadbaran City in the province of Agusan del Norte, married to Fe Eligeno and has 5 children, a resident of Cumagascas, Cabadbaran City, is such a classic rag.
Ruben says, "Life is difficult but he is seasoned with trials!" Proud to have risen above the many big challenges he encountered to make the CARP awarded land more productive and profitable.
Today, he is one of the successful vegetable growers in Sanghan, Cabadbaran City.
In 1990, after he finished High School, he wanted to pursue a college education, but because of their economic status he had to work part-time as a helper at Sanchez Rice Mill in Cabadbaran City. Working long hours as a cheap wage earner competed with his desire to pursue college degree, his earning was not even enough to provide him basic school needs.
In 1993, the landholding of Antonio Avanceña was covered by Comprehensive Agrarian Reform Program (CARP). Ruben, was one of the farm workers who was awarded with two-hectare land which he initially planted with corn. With his aspiration to have a college degree he decided to abandon his job at Sanchez Rice Mill to focus the more profitable work of tilling the awarded land.
In 1997, the two-hectare Certificate of Land Ownership Award (CLOA) was finally awarded to him. Failures were repeatedly made leaving him with insufficient income. Their house continued to drip with ruin nipa and bamboo slats. Pest and diseases, natural calamities and trader-controlled prices were among the challenges he faced. But Ruben never gave-up, every challenge was a lesson learned.
With DAR's provision through capability building seminar, Ruben developed his confidence until he came up with a brilliant idea that will solve his problems. In the year 2000, he sought the help to learn more techniques on integrated and diversified farming system.
He planted his farm with vegetables, like eggplant, ampalaya, tomatoes, and pepper then intercropped the vegetables with papaya. With an initial capital of P 87,300 for eggplant alone he earned a net income of P 355,043.00.
According to Ruben, "An estimated area of 700 square meter plot is also planted with tomato at a cost of P 12,870 and made a gross income of P 31,740 or a net income of P 18,780.00."
Vegetable farming doubled Ruben's income that he estimated annual gross earnings of P400 thousand. Ruben said, "Our best production comes from eggplant, which we harvested regularly two times a week."
When Ruben was asked why he chose vegetable farming over corn, he promptly answered that vegetables have shorter gestation period and much more profitable than corn.
Ruben is now a popular and successful off-season vegetable grower in barangay Sanghan. Sometimes, he always has farmer-visitors asking some help about his practices and techniques to which he always answered – "Right technology, coupled with perseverance and hard work."
Ruben also participated in many civic works. Giving back to the community, he is willing to become an advisor to those who want to try their hand about becoming an entrepreneur.
"You don't need a large piece of land to cultivate, what is even more important is you have the skill how to maximize and use your resources," Ruben said.
"My determination to adopt innovative growing techniques on Integrated and Diversified farming system eventually become an inspiration to other farmers in my community. I am very much thankful to Department Agrarian Reform (DAR) for its continuing intervention to improve the lives of farmer-beneficiaries. In return I am now their success story. They are now proud of me as I am a proud of being a farmer." Ruben further said.


text:
"The DM clan is the top ranked clan for medal of honor: heros. We are a friendly and helpful community and we always work together. A BS FREE ZONE! Some come check us out, you'll love our forum too!"
Top site lists are a simple, but powerful system for exposing your site to millions. If accepted into our exclusive network this is a great opportunity to grow your site.
Pick a unique URL: top-site-list.com/your-name. Add a custom logo and background. Your choice of over 275 styles for your toplist, or provide your own custom HTML layout.
4,634 Top Site Lists
250,835 Members
1,053,333 Listed Websites
313,862,229 Total Votes
572,539,662 Total Hits