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ABA therapy and insurance: What you need to know

Many families with children affected by autism are currently reviewing insurance options during the Affordable Care Act open enrollment process. Here are four things to keep in mind as you consider ABA therapy and insurance:

ABA therapy insurance coverage is different with each policy. Coverage is dependent on whether your employer is self-funded or fully funded. Your prospective ABA center should contact your insurance provider to determine if ABA therapy is a covered benefit and what co-insurance/co-pay is applicable to your policy. Little Star Center accepts most insurance plans and, with the assistance of our family services director, works closely with families to address policy issues.

If your insurance plan does not cover ABA therapy, we encourage you to speak to an insurance broker familiar with the treatment and specific insurance need. It is important to work closely with your prospective center and insurance broker during open enrollment to ensure adequate coverage. Please remember open enrollment closes Jan. 31, 2016. After this deadline, insurance policies and rates are locked in until the next enrollment cycle.

Once insurance coverage is verified, your child’s start date for enrollment will be set. At Little Star Center, we have a step-by-step process that takes two to three weeks to complete and will ensure insurance coverage is in place for services.

If you do not have insurance, please contact an insurance broker who can assist you with options for ABA therapy coverage.

Remember these important dates during open enrollment:

  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016
  • January 1, 2016: 2016 coverage starts for those who enroll or change plans by December 15
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: 2016 Open Enrollment ends. Enrollments or changes between January 16 and January 31 take effect March 1, 2016

To learn more about ABA therapy and insurance coverage, visit the following websites:

Written by Victoria Blessing-Wade, Family Services Director at Little Star Center. Email Victoria at [email protected] with any questions about enrolling at Little Star Center.  

A learner’s journey to the barber shop – Little Star Center-Bloomington

One of our learners at Little Star Center-Bloomington has been working on hair cutting desensitization with his therapist. Getting to the stage where he is comfortable sitting for a haircut has been a gradual process which included allowing the therapist to touch his hair, sitting in the waiting area and touching the styling chair. The learner has been able to sit back in the styling chair at our center for two minutes without any unwanted behaviors!

Recently, he and his therapist visited a local barber shop to sit in a styling chair. He successfully sat in the chair and allowed his therapist to trim his hair!

Middle Star learners get fit at Little Star Center in Carmel

Fitness group at Little Star Center in Carmel is a great opportunity for Middle Star learners to  establish healthy habits.

Fitness group meets once a week for a variety of activities, including   stretching, group movement games such as relay races or tag and ball activities. Learners also practice using fitness/cardio equipment.

Additionally, there are opportunities for learners to practice following instructions and focusing on imitation, as illustrated by the two learners pictured above who are mirroring one another’s movements during a stretching activity!

 

Outings reinforce skills for learners at Little Star Center

The goal of our programs at Little Star Center is to make the best use of each learner’s day and teach them the skills needed to be as successful as possible in a daily settings. One of the ways we achieve this goal is through various outings. Little Star Center learners have an opportunity to practice new skills in different settings, including restaurants, parks and the local library. Here are few examples:

Outing to the Indiana State Fair – Some of our Middle Star learners in Carmel practiced using community transportation by riding the train to the Indiana State Fair. They also followed directions on a scavenger hunt, tried new foods/experiences and had many valuable social opportunities.

Sensory Story Time at the Monroe County Public Library – This outing is always a treat for our learners at Little Star Center in Bloomington. Every month, learners have the opportunity to practice their group skills. They worked on attending and responding to a novel group leader, following directions, singing songs, imitating actions as well as listening to a story.  After story time, the learners practiced sharing play sets with one another. One of our learners decided to have some fun. He knows his name quite well decided to be called “Little Guy” when the Story Time leader asked him his name.

Thank you to all community businesses and leaders who have hosted our outings. We hope you’ve enjoyed the experiences as much as our learners have.

Learners get “sweet” reinforcement at Little Star Center-Bloomington

Tasting pic collage

Food pairing with any learner or person with or without disabilities has to be individualized! During the month of April, our learners at Little Star Center-Bloomington were introduced to different foods in an attempt to reinforce tasting one new food per week.

We specifically picked out food that the learners could put together as well as try. The foods were with bright colors, sweet and, yes, sometimes, sugary! Some of the foods included were chocolate with granola over apples, “Ants on a Log,” which is cream cheese on celery with raisins and Rice Krispy treats. The goal was to have 100 percent of our learners try new foods!

Trying the new food was defined as taking one bite.  If the learner took more than one bite, that data was not collected.

So far, we have seen two of our learners generalize this skill to their home environment.  One learner only ate Kraft Macaroni and Cheese and Cheez-Its every day she came in for therapy.  Since we have started tasting new foods each week, this learner is now requesting that her mother pack her fruits and vegetables in her lunch.  One day, this learner’s lunch consisted of carrots, celery and strawberries.

Another learner apparently took a piece of celery that was on his mother’s plate.

Sweet success!

20 Insights from 20 Years of Experience as an Indiana ABA therapist

By Jennifer LaMarca

I’ve been blessed to have spent the last 20 years providing early, intensive ABA programming for young children with autism in their homes.  From working in Dr. Lovaas’ Young Autism Project replication site as a therapist, to being the first early, intensive ABA consultant residing in Indiana, my experiences have certainly shaped the treatment I provide.  Here are 20 insights I’ve gained over those 20 years:

1.  ABA is all about the play. Language gets all the attention because we certainly want to help a young child who isn’t talking, but a core symptom of autism is difficulty with social interactions.  Quality early, intensive behavior programs should have at least three to five play programs running at all times.

2. ABA therapy isn’t about what you KNOW, it’s about what you can DO. It doesn’t matter if you can tell me how to play with a child or reinforce a skill…let me see you play with the child and reinforce the skill!

3If a child can’t learn a skill one way, there are at least ten other ways to teach the same skill. A program with little to no progress for more than a week needs to be looked at and tweaked immediately.

4. Knowing about ABA or implementing a couple ABA procedures is not the same as being a behavior analyst. That would be like calling me a doctor because I know how to put on a band- aid and take a temperature.

5. Parents are always right. Except when they’re not.  But trust me, one of the best things young behavior analysts can do is recognize they are in collaboration with parents rather than above them.

6. Lovaas was a trail blazer! He had the audacity to believe that applying behavioral principles at all waking hours – forty hours a week by therapists and then throughout the remainder of the day by parents – could lead to life altering progress for young children with autism…and boy was he right!

7.  Parents need to do the therapy, too. The Chinese proverb applies here: “I hear and I forget. I see and I remember. I do and I understand.”

8. ABA therapy is a balance between motivation and tolerance. Look at the older books on ABA for autism and the emphasis is on compliance – attending to a task, complying to a request – but look further and motivation is mentioned, too.  Look at the newer books on ABA for autism and the emphasis is on motivation – following the child’s lead, pairing with reinforcement – but look further and compliance is mentioned as well.  The best behavior analysts find the right balance at the right time for the right child.

9. It’s possible to do an early, intensive ABA program and never sit at a table and chairs. When’s the last time a typically developing three-year-old sat in one place for more than two seconds?  Young children are active.  We should be taking advantage of that.

10. Reinforcement is anything that increases behavior…ANYTHING. Therapists should be looking every day for a new reinforcer because the options are limitless!

11. ABA is not rocket science…it’s harder. ABA is about interacting with wonderfully diverse human beings in a meaningful way.  It’s not just some abstract mathematical equation that you can master over time.

12. What happens during breaks is just as important as what happens during structured time. There’s certainly a time and place for children to be free to play alone, but sometimes the best interactions and best generalization occur during the unstructured time a therapist spends with a child.

13. Best-outcome results are both possible and frequent in ABA therapy. It is true that there is no cure for autism, and, it is true that not all children with autism will benefit to the same extent from ABA therapy,but, it is also true that 30-50% of children who receive quality, early, intensive behavioral intervention will go on to regular education classrooms without support and maintain their gains into the future.  Multiple studies have shown this to be true, and I’ve certainly seen it, too.

14. Before you start placing demands on a child, it’s often helpful to already be engaging with them in a meaningful way. We call this by different names, but long story short, if the kid is already having fun with you, he’s much more likely to humor you and respond to your request.

15. One-to-one ABA therapy from therapists is only one part of a comprehensive early intervention program. The other parts include parent involvement, sibling and peer play, and when the child is ready, a transition to school facilitated by an ABA therapist that lasts over a period of years.

16. If a child with autism has a sibling, consider different ways to involve them in treatment. Involving a sibling in play, teaching a sibling how to interact with his/her brother or sister, or even practicing some programs with a sibling so they get a little extra attention as well, are all ways you can potentially support brothers and sisters.

17. There are lots of gimmicks in autism treatments..and some even in ABA therapy. The behavioral principles on which ABA is founded haven’t changed.   But there sure are a lot of new brand names, new strategy names, and new supplemental treatments popping up in ABA therapy.  Quality ABA programs continue to provide the same thing: an intervention based on the science of behaviorism, applied in a meaningful way, and continually analyzed to make sure maximum progress is reached.

18. ABA isn’t just a therapy, it’s a way of life. Effective treatment does require parents to learn the techniques of ABA that have made their child successful.  Parents do have to try to implement these strategies throughout the entire day.  But this isn’t because you’re always doing therapy.  It’s because when you come to understand ABA, you see its application in all aspects of life – not only your child’s, but also your own: parenting, coaching, working, teaching, spending and saving, and staying healthy just to name a few.

19. If a child learns a skill, then loses a skill, think twice about whether to teach it again. We teach basic skills so they can be used with more complex skills so they can be used and reinforced in everyday life. If a child loses a skill, then it’s not being used and/or it’s not being reinforced in everyday life.  Teaching the skill again doesn’t change either of those two facts.

20. If the child cannot learn in the way we teach, we must teach in a way the child can learn. Lovaas said that over 20 years ago. It’s still the best ABA mantra I know.

Jennifer LaMarca is an in-home program manager at Little Star Center. 

ABAI conference provides latest autism information for Little Star Center – Indiana ABA therapy facility

By Tim Courtney, senior clinical director

In keeping with its mission to provide the most effective interventions for learners, Little Star Center, an Indiana ABA therapy facility, is reviewing strategies learned recently at the annual Association for Behavior Analysis International autism conference in Las Vegas. Little Star sent three members of its staff to the conference, which focused specifically on the most current science-based approaches in assessment and treatment of autism.

More than 700 attended the January event, featuring prominent experts in autism:

Dr. Linda LeBlanc focused on procedures to teach individuals with autism to attend to both visual and auditory information when making discriminations. Individuals with autism often rely too heavily on one or the other. Dr. Leblanc provided several suggestions for strategies that we are reviewing as part of a teaching procedure review committee.

Dr. Gregory Hanley presented on an intervention to strongly consider when conducting assessments to determine why someone is engaging in problem behavior. He recommended that behavior analysts should not rely too heavily on just interview and similar assessment tools. Little Star will review the assessment procedure Dr. Hanley recommended and will make relevant modifications to our current behavioral assessment procedures.

Dr. Wayne Fisher discussed the new CPT codes. Dr. Fisher was an ad-hoc consultant for the committee that developed CPT codes. As a result of this discussion, a group of providers met after the first day of the workshop to discuss current challenges with implementing the codes. During the meeting it was decided to continue meeting as a small group to solicit information from other behavior analysts and develop tools to assist practitioners in implementing the codes. The group is currently working on a Wiki and procedures for surveying practitioners currently implementing the codes.

 

Family thankful for Indiana ABA therapy services at Little Star Center

By Clayton Sheese, Little Star Center dad to Jacob, 8

How long has your child attended Little Star Center?

Since March 2011

What has been the biggest challenge in finding services for your child? 

Our biggest challenge has been finding insurance coverage for ABA therapy. We were lucky to get a child-only policy from our insurance carrier when Little Star-Lafayette opened — and before the insurer stopped offering such plans. Then, over the years, the premiums increased and we were paying double the original cost.

As Jacob became school-aged, our insurance carrier pushed for him to attend his area school and cut his hours at Little Star in half. We went through all the appeals. The first was handled by Little Star, but was denied. Second appeal also was denied. Shortly after learning a second appeals board overturned the previous decisions, we learned that decision only covered the first appeal, forcing us to begin the process all over again!!! Now, we have to go through the application process every six months.

Jacob is now in school half days. He has settled in pretty well! We feel he needs more time at Little Star in this stage of his life.

How has Little Star Center provided support to your family? 

Little Star was there with us through the appeals process, and we are appreciative of that. During the appeals process, Jacob was able to stay at Little Star 40 hours a week! We are very grateful that Little Star found a way for Jacob during our challenges with insurance! We feel ABA is the best thing for Jacob! He has made leaps and bounds!

 You could have chosen other ABA facilities for your child. What makes Little Star Center stand out from other ABA facilities? 

Little Star was our first choice. We went to Carmel and toured the facility. When the Lafayette center opened, everyone was so helpful and kind!

For what are you most grateful at Little Star Center?

We are grateful for everything Little Star has done for Jacob. He has come so far since he has been at the facility! It has been a long road! We have some challenges ahead, but we know Little Star will be there for Jacob and our family!

“Little Star is the only facility we know of where they put the child first…”

By Joanne Kehoe, Little Star Center mom to Anthony

What has been the biggest challenge in finding services for your child?  In the beginning, our biggest challenge was finding out what was possible for Anthony.  He was in First Steps, but he aged out when he was 3 years old. Then, he started at a developmental preschool at our local public school.  We found that, at the public school, there seemed to be very little knowledge about kids with autism, and we were extremely disheartened.  A family friend, a psychiatrist at Riley, mentioned Little Star to me.  We went to Little Star and liked it, and began the process of finding out how we could get insurance to cover it. Since my husband works for the federal government and their insurance plan is self-funded, they do not have to provide coverage for ABA therapy.  A mom at Little Star gave me contact information for her insurance (representative) and we were able to get Anthony his own policy so that he could get his ABA therapy covered.

How did you overcome that challenge?  We were lucky that so many people were willing to share information from their lives to help us move through ours.  If we left it up to the public schools or the state – people who are supposed to help us – we would still be struggling!

How has Little Star Center provided support to your family?  When Anthony started at Little Star, I remember very clearly when his program manager came to our house and asked us what we wanted for Anthony.  We wanted him to be able to attend church and communicate with us so we could help him.  I will never forget sitting at my kitchen table with the program manager and being amazed that these things were possible.

Anthony is the oldest of four children, and his younger sisters Maria and Veronica, ages 6 and 5, have been welcomed at Little Star for sibling play and they love it. It has gone a long way for them to see that Anthony is not the only person they know with autism.

During the last year, when we have been fighting with our insurance company, doctor and, seemingly, everyone about coverage for ABA therapy for Anthony, only the people at Little Star have been there to support us. They have offered financial support so that Anthony could still go to Little Star and not have his schedule disrupted.  The people at Little Star have gone above and beyond what I would expect anyone to do for Anthony and we can’t say how much we appreciate it.

You could have chosen other ABA facilities for your child. What makes Little Star Center stand out from other ABA facilities?  Little Star is the only facility we know of where they put the child first, give him what he needs, and not focus solely on making money and billing.

For what are you most grateful at Little Star Center? We are grateful to have people working with Anthony who not only know what they are doing, but who truly love and care about him.  We know that the (concern) they have for Anthony is at the basis of all of the care they give us and we are forever indebted to them.

 

 

 

Thank you, Little Star Center for quality ABA services in Bloomington, Indiana

The following comments are from a mom with a newly enrolled learner at our Bloomington location.

As a parent of a child recently enrolled in the Little Star program, I would describe my experience in this process as nothing short of exceptional!

Enrolling your child in an intense therapy program can be extremely stressful for your child, as well as for yourself as the parent, and the other members of your family. Little Star’s staff removed these stresses for all of us.

The staff was professional, knowledgeable, organized, efficient, and, above all, compassionate throughout every phase of this process. They look at your child and their family as individual entities with specific needs and they work with you in order to make it possible for your child to receive these much-needed services.

I had many concerns from previous experiences with other centers and the many challenges facing me as a parent in trying to seek out ABA services for my son. They have worked with me tirelessly and patiently to facilitate services and to meet every need of my son and our family. They are genuinely compassionate and committed to providing the best services to the children and their families! We are forever indebted to this wonderful organization!