Intro: Riverside Healthcare puts the health and wellness information you need well within reach.

Taylor Leddin-McMaster (Host): Hello, listeners. Welcome back to the Well Within Reach podcast, brought to you by Riverside Healthcare. I'm your host, Taylor Leddin-McMaster. And joining me today is Tina Sullivan with the Riverside ABA Therapy Clinic; and Drew Haverstock with Milestone Therapy. Thank you for joining us today.

Drew Haverstock: Thanks for having us.

Host: Before we get started, we're going to take a quick break for a message about myChart.

MyChart ad: Healthcare can be confusing, but thanks to your my Riverside myChart, you can easily manage not only your care, but your family's as well. With a single click, your myRiverside myChart lets you stay well connected to the same information your provider sees. You can view your health history, get test results, request prescription refills, pay your bill or make an appointment. Manage your care from anywhere, your laptop, phone, or tablet. Learn more and enroll today at riversidemychart.org.

Host: And we're back to discuss the new ABA Therapy Clinic at Riverside. First, I'm going to have our guest tell us about their clinical background. Drew, if you could tell us about yours.

Drew Haverstock: Certainly. I actually went to college at Indiana University down in Bloomington. I got a business degree first and found out I did not like the Fortune 500 world. So, my wife is a speech therapist. I met a bunch of her therapy friends, and I decided that I wanted to be a PT when I grew up. So, we left Florida. I was born and raised in Chicago. I was accepted at UIC's Physical Therapy Program. Graduated in 2001 and started Milestone Therapy in 2002. So, I'm very fortunate to be in a position today where we're able to help kids with physical occupational speech therapy and, since 2017, doing ABA as well. So, very happy to be where we are right now. Very happy to be with Riverside.

Host: Fantastic. Thank you. Tina, what about you?

Tina Sullivan: Hi. I started off in the field of ABA in 2013. I stumbled upon this field because of a friend that worked in the field and I was inspired to continue and maintain my place in the field beginning at that point. I joined Milestone in 2019 in their ABA department, and I've since then worked my way from becoming an RBT to a BCBA. And I'm looking forward to the growth that we have with Milestone and Riverside ABA.

Host: Fantastic. So to start things off, Drew, can you tell us about what ABA therapy is and how it helps children with autism?

Drew Haverstock: Certainly. ABA therapy stands for applied behavior analysis and what it does is it works specifically on children who have a diagnosis of autism. And in its most base level, the phrase I always come back to is that we take a look at the behaviors we want to see more of and we reinforce those. We help the kids recognize what we want to see more of and encourage that.

In the same sense, when there are behaviors that we want to see less of, less desirable behaviors for whatever they may be, we redirect and that way help children learn at its most base level, again, that they are rewarded for doing more stuff that we want to see and then just simply redirect it away from the things that are less desirable, I think is the easiest way to look at it.

Host: Great. Tina, what makes this new ABA therapy clinic unique and what age group of children is it specifically designed to support?

Tina Sullivan: What makes our ABA therapy clinic unique is that we are a pediatric ABA center with our primary focus being on functional communication skills, building replacement behaviors, and working closely with the families to support the generalization of the skills that they're developing in the clinic. The focus of our treatment would be children with an autism diagnosis from ages two to ten. We strive to create a space where families feel heard and where treatment plans are directly tied to what matters most to the families and their children in their day-to-day life.

Host: For listeners, the new ABA clinic is located at the Atrium, Riverside's Behavioral Health Building. That's also where our immediate care is and some other locations of Riverside. Who can refer a child to the Riverside ABA clinic? And do families need a formal autism diagnosis before reaching out?

Drew Haverstock: That's a great question. Thanks for asking. Yes, kiddos need to have a formal diagnosis of autism in order to receive ABA therapy services. That's the easy part relatively. The harder part is how do you go about getting it. So, I encourage all parents to start with their general practitioner or their pediatrician, and have a discussion there about what's going on with their child to start identifying some of the symptoms that's made them believe that their child may have autism. From there, there's a very-- I hate to say it-- but long and arduous process that they'll have to go through, where they're going to wind up connecting with a pediatric developmental psychologist, for example, who will do some extensive testing in order to formalize that autism diagnosis and allow the process to begin.

Once that evaluation is completed, they are then referred to us at our facility and we go through a series of background checks and make sure that the child is appropriate for the services to be rendered. Once that decision's made though, our BCBA's on staff, those are the board-certified behavior analysts, they'll do another evaluation themselves. Eventually, those two evaluations are married, sent off to the insurance company, and then a decision is made as to whether or not services are going to be allowed.

Typically, if we have all of our I's dotted and T's crossed, we're good. But it should be noted that the service length and the volume of work for children who are getting ABA services is significantly longer and larger in scope than it would be for something on the medical side, like PT, OT and speech. The episodes of care in PT/OT or speech are anywhere from three months, six months or something like that. And then, you re-up after that. And visits typically are for an hour a week or so.

In the world of ABA, children often are in our clinic daily for anywhere between four and six hours. So, they can be getting between 20 and 40 hours of therapy a week. And so, there's higher level of scrutiny to allow these children to qualify for the programming. But beyond that, the level and depth of the programming is significantly different than what we do in PT/OT and speech, and that is where Tina and her crew come in, because they're excellent about capturing the data over time, making sure that progress is being made and constantly updating that plan of care to ensure we're moving in the right direction. It's very cool the longer you get the chance to really see what's happening, it's very, very neat.

Host: I would imagine.

Drew Haverstock: It's very neat to see what happens with these kids.

Host: Yeah. Tina, once a child is referred, what does the typical timeline look like from first contact to beginning therapy?

Tina Sullivan: So currently, we are still building and developing all the systems needed to operate at this location. And so, some of this process might be a little bit longer at the onset of services and as we're opening our doors. But ideally, once we are receiving the referral, the family will hear back from the clinic coordinator. They'll make sure that we have all the documentation needed to request authorization. We request for about a nine-month window just to ensure that we are able to complete the assessment in that time period. But what we're looking at really is, from the point of having all of our documentation to the clinic coordinator, which would include the diagnostic assessment, the referral, all those necessary items, at that point, we would ideally look to schedule, have the documentation needed via the direct assessment, the family contact, and the communication with them, gathering the background information.

And then, once we have met with the family and scheduled the initial assessment, we're looking at ideally about 30 days, possibly a little bit more from the point of the completion of the direct assessment, the writeup of the plan, the request of authorization, and then we send all that off to the insurance company. Authorization from the insurance company can take anywhere from two weeks to about a month. So, that part of it is variable based on the insurance, how quickly they're able to move through their requests. But ideally, when we're operating the way we plan to be, it would look like approximately a month between the scheduling of the assessment, and then the actual beginning of services, a little bit longer possibly based on insurance factors and things of that nature.

But we are looking for it to be a pretty quick process. There are some documentation and making sure that we have all of our I's dotted and T's crossed to make sure that we have everything we need to get authorization. But in an ideal world, we would look for that to be about a month, possibly a little bit longer with some wiggle room, just making sure to allow for the time for the authorization request to be approved by the insurance. And at that point, we're acquiring the staff we need to fill the teams, making sure that we have all the other necessary items on the backend completed while we're waiting for authorization. But in an ideal world, that's what it does look like.

Host: Okay. Thank you for that. Sounds like a little bit of work is involved. Before we continue our conversation, we're going to take a break to talk about the importance of Primary Care.

Consistency is being able to count on someone to be there when you need them. At Riverside Healthcare, your primary care provider is dedicated to being in your corner, helping you and your family stay healthy and thrive. Find the right primary care provider for you at myrhc.net/acceptingnew. From annual screenings to well checks and everything in between, having a primary care provider that you can trust makes all the difference.

We're back with our conversation on ABA therapy with Drew and Tina. Tina, can you tell us what a typical day or session looks like for a child receiving ABA therapy at the Riverside Clinic?

Tina Sullivan: Yes, I can. Each day is highly structured, but designed to be fun and engaging for our clients. So, they are meeting their RBT, which is a one-to-one service provider, registered behavior technician. They are working with that individual throughout the course of their time at the clinic. These RBTs are working under the supervision of board-certified behavior analysts or BCBAs. This session looks like a blend of structured teaching, including naturalistic opportunities.

So, an example of that would be like snack time is a great opportunity where we're working on functional communication. Engagement with peers is a great opportunity for social connection. Working on mending. We're constantly establishing motivation through the presentation of different play activities, games, finding out the interests of the clients, and really capitalizing on those interests and using them as motivators throughout the session to build the skills that we are setting out in the treatment plan. So, sessions are balanced, incorporating play functional communication opportunities for social engagement, while we're working on the treatment goals.

Host: Awesome. Drew, can you talk about how the clinic works with parents or caregivers to support progress at home and school?

Drew Haverstock: I can, because this is kind of my favorite part. What we do is very important on the day in and day out basis, right? Tina mentioned the hard work put in by the RBTs and the BCBAs, who are orchestrating all of it, right? But none of it comes together. If we're seeing a kid for four hours in a day, let's say they have a 20-hour plan, five days a week, four hours a day, they're still with their family for the other 20 hours of that day, and there needs to be carry-over into the home and into that natural environment for us to have long-term success.

Because if we're teaching you certain set of goals and behaviors that we're working towards here at the Atrium, what needs to happen, as Tina mentioned earlier, is there needs to be kind of a generalization of those skills. They need to be carried over into the home, into the shopping trips, to Target, into dinner at Chili's or wherever it may be, right? You want these families to be able to go out and do things as a unit, and the only way they can do that is if we're using similar phrases, similar reinforcers, and there's a regular expectation to be very clear. It's an expectation of parent education that occurs during ABA every month, and I think I could turn it over to Tina for a second that could maybe describe a little bit about how that works.

But the parent education process is wonderful because it's laid out exactly what they need to do, how they can continue to encourage their child to see the things that they're hoping for and what we are doing to constantly help modify that plan of care to allow them to progress further and further towards functional independence. Tina, do you want to chime in a little bit about what that looks like?

Tina Sullivan: So when we're beginning services, we're connecting with the families right from the beginning of the process. And so, we are meeting with them during the course of writing the treatment plan to make benchmarks with them to determine what their child being done with ABA services looks like.

And what we do is we break those down into smaller, measurable goals that are incorporated throughout the process of the ABA therapy and incorporating them into goals that the parents are working directly towards at home that are in line with what we're working on at the clinic so that what we're working on the clinic doesn't just stop there. They are actually able to generalize the skills into the home setting, school community. And so, just empowering parents to be able to take the skills that their children are developing in the clinic and using them in different ways where they're finding value in them outside of the clinic and able to use them then for the rest of their lives.

Host: Yeah, that makes sense that there needs to be cohesion in everyone who's involved. So when looking at progress with this type of therapy, how do you measure that progress and what kind of outcomes do you hope to see in children?

Tina Sullivan: So, we do measure progress through objective data collection methods. So when the RBT is working with the child in the clinic, we are collecting data on each of the goals set out in the treatment plan. We are also collecting a lot of information in other ways that is not necessarily related to the targets that we're working on through the treatment plan, but we're also collecting data on the preferred items that the client has, any behaviors that we're seeing engagement in, and we're taking all that information and using it to guide us in our treatment through the process of delivery of the ABA services. So, we're using that information to drive and make changes if necessary based on the information that is objectively measured during the sessions collected by the RBT and reviewed by the BCBA on a regular basis during supervision and just through the progress of the delivery of ABA services over time.

Drew Haverstock: Yeah, the level of attention to detail is pretty amazing. As she mentioned, everything is captured. And even some of the things that are occurring that may not directly apply to what are the goals they're currently working on, since things are done in episodes, and every six months we'll re-up and change it, looking at what direction the child's going. The amount of data that they capture and that the BCBA churn through in order to modify that plan of care almost makes me feel guilty as a physical therapist, because I'm looking at running, catching, throwing, kicking, things like that. But the nuance to what the crew in ABA digests is nothing short of amazing. It really is neat to see.

Host: Yeah, that sounds incredibly interesting. Switching back to what we were talking about a minute ago about parents, what would you say to a parent who's feeling overwhelmed or unsure if ABA therapy is the right next step for their child?

Tina Sullivan: That's a great question, and I'm sure one that many families encounter. But where I would start is just thinking about what the goals they have for their child are, and then if there's any desire to explore further if ABA could be of assistance to their family. And usually, there is some support that can be provided through replacement behavior. If there is any challenging behaviors that their child's exhibiting, if there's any challenges with building functional communication or functional replacement, a lot of those are areas that we can support through ABA services. So, I would say just determining what the most important priorities are for their child, and then also just reaching out to see if there is any way that ABA services could be of assistance to them. We definitely have people that would be willing to chat and just talk a little bit further about if the goals they have for their child would align with what we are able to do with ABA services.

Host: Okay. So if a parent or provider is interested in learning more or referring a child, what is the best next step?

Drew Haverstock: Best next step is to make a call. Currently, we are still getting the phone system set up where they need to be, over at the atrium. So, we're using the main Milestone number for now. So, it'll be 219-513-8311 and extension 5 will get you to the crew that handles our ABA services and they'll be able to take it from there.

Host: Perfect. And for more information on Riverside Behavioral Health, which is overseeing this facet of Riverside, visit riversidehealthcare.org and go to services.

Thank you both so much for your time today and for informing myself and our listeners about ABA therapy. And thank you to our listeners for tuning into the Well Within Reach podcast, brought to you by Riverside Healthcare.