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Maryland offers "The New Directions Waiver" as a means of self-directing state and federal Medicaid dollars for individuals who qualify for supports due to their disability.

This offers the disabled individual the opportunity to use those dollars to best meet their own unique needs. However, it comes with the responsibility to create a plan, a budget, and find your own resources to make the plan a reality.

No centralized source of resources exists. The purpose of this blog is to direct others to resources in our communities and to provide one example of a self-directed plan. (*Caution: The self-directed plan described at the beginning of this blog is for an individual with a 5/5 needs rating, the highest possible rating in Maryland, and therefore the highest budget possible. Most will have a lower rating and a lower budget to work with.) It is also to share firsthand knowledge of experiences that may assist others who self-direct services.

Comments are welcome. Please share your knowledge with others.

Wednesday, April 14, 2010

Fitness for Health: 2nd Visit

Just because Nyle (V's O.T.) and I were impressed by the facility and founder of Fitness for Health, didn't mean that V would feel the same. The only way to decide if the center would be a good fit for V was to take her there to work on the equipment with the FFH trainer that would be working with her as a client. Today we did that. I was hoping that Nyle could join us, but her schedule didn't allow her to be present again, but since we had left her evaluation with Marc when we went for the first visit together, they were prepared.
The timing of the visit was not ideal because they had several other children there who were very active, loud, and dealing with emotions... all issues that could have caused behavioral issues with V. She handled the sensory load pretty well. First, she saw a bag that someone had left on the trampoline, grabbed it and looked inside and found food. Uh Oh. Food obsession triggered. It was tricky getting it away and out of site, and required that one of her own snacks be retrieved from the car and brought in for her. Time was lost to snacking. Now they know not to have food laying around when she comes again. We went first to the the larger of the two rooms that use a black light and floor lights to make equipment glow in the dark. V surprised us all by kicking around the glowing soccer ball. I didn't know she could or would kick a ball, so that was good to see. The balloon caused a little sensory overload and V needed to sit down and collect herself before continuing. Then we went into the main room with the rock wall and 30 foot long trampoline. She walked with me over several long, 10 inch thick floor mats that made for a nice, unsteady surface. Good. Walking on unstable surfaces is one of her OT tasks to work on her balance. She walked on the trampoline. Good again. We tried out the equipment that required her to tap on various lights to put them out and involved bending, stretching across, and stretching up, along with visual and auditory tracking. At first we motivated her to tap the lights with stickers, but soon she became so engaged with the activity and the verbal praise that everyone was giving her, that she forgot about the stickers and only cared about finding and tapping the lights. For a first visit, she engaged quickly in each activity presented and experienced fun and success. She was in no hurry when it was time to go, and turned back around to the tire swing and crawled into it, hanging on it, smiling happily.
My decision was made. I can see that she can make progress on her goals at this place, where the staff are patient, skilled and understanding, the activities are motivating and fun. The staff agreed that she could benefit from the activities that they have to offer. Now I have to write it into the plan of care and budget for the new fiscal year, and justify it well with the O.T. evaluation and goals. I am crossing my fingers that it will be approved.

Tuesday, April 13, 2010

Good News for Asperger's and High-Functioning Autism or PDD

One of my Google Alerts about the latest research including an interesting article about a summer camp for youngsters that are on the autism spectrum, but high-functioning. Although, this description does not apply to V, there are many out there that might find some hope for improved social skills from reading about this program.
To get the whole story, copy and paste this URL :
http://www.canisius.edu/newsevents/display_story.asp?iNewsID=6402&strBack=default.asp

Bubble Blowing Happiness

Last night I came home and checked in on V and her staff. I found Aisha holding out the wand of bubble liquid to V's face and V was blowing with all her might and then reaching out to catch the bubbles. Aisha was laughing and praising V, and I joined in with clapping and approval. They were happy and having fun and I was happy too. First because Aisha was repeating an activity that she had observed during an OT session and was reinforcing the work that she knew Valerie needed, and second because V was doing so well and enjoying herself.
I couldn't wait to share my observation with our OT, and Nyle wrote back,
"You know, when I first started working with V*****, she couldn't blow a bubble because her oral-motor muscles were too weak and she couldn't calibrate her blowing to get enough force. This activity is very good for building up the muscles she needs to form words more clearly. It's also good for eye tracking and convergence, which helps to integrate the brain."
What a little thing, so insignificant to most children and parents, but important to us because it shows progress toward more important skills. Staff reinforcing what they observe specialists doing is what I have wanted to see and I am seeing it, more than ever, now.

Friday, April 9, 2010

Real Feelings

It occurred to me that someone reading this might think that I am always hopeful and optimistic about V, our life and her future. Most of the time I just think that I wouldn't make anyone's life any easier by whining about the way that I hoped or wished things would be or should be. Most of the time I accept and live in the reality of our situation, counting my blessings and recognizing that it is hard to raise a child without any disabilities too, just in a different way. I have not had that pleasure myself, and I tried to share in it vicariously by teaching elementary school for a few years. It's not the same. Those children move on with their lives and most forget you were ever a part of their day to day routines (I think).
Like other parents who are told that their child is not developing normally, I got scared and sad, and grieved for the lost path that I thought we were going to take. I left the world of "This is what happens next in your child's development" and joined the world of "Who knows what will happen next, or when it will happen". I might as well have thrown away the child development book that I studied in college that explained what is typical at 2 years, 3 years, etc. There was no book and no person who could provide answers to questions like, "When will she talk?" "When will she learn to dress herself?" and "When will she read?" My only option was to love her, give her what help I could, and wait to see what would happen. Over time I learned to be her voice and to advocate for her with teachers, therapists and doctors. Sometimes I became really angry and frustrated with them all.
I tried to join a parent support group when V was very young, but came home from each meeting with a headache from the stress I experienced in those meetings. They were years ahead of us in their experiences and I could not relate to the things they were dealing with, but it frightened me that I might someday be able to. So, at that point, I determined that our lives were not going to revolve around V's disability. We were going to have lives that were as normal as possible, and I would do what I needed to do, but not immerse myself in the subject of what was wrong or missing in our lives. That was how I functioned without becoming overwhelmed by how different our lives were becoming from that of my friends. It was lonely and isolating being the only person I knew who was dealing with our particular kinds of troubles. As a single mother, I had no partner to share the ups and downs with. When V was very little, she was included in birthday parties that my friends with normal children held, but as she grew the invitations stopped coming. There were no invitations to come play and no little friends coming over to play with V, just the two of us at home. The children of my friends had grown and moved on to socialize with other children at their own developmental level. V was left behind, and me along with her. I continued to get together with other adults on my own when V spent the weekend with her dad, or I had a sitter, but the strong chance that V would have a meltdown and become aggressive or destructive, kept her from being part of those activities. Peers, outside of school, were non-existent. I could not imagine what it would be like to grow up without friends the way that she had to. I have always recognized that no matter how hard it has been for me to care for her at times, it has always been harder to live in her head 24/7/365. At least I got breaks to live a normal life, to escape stress and frustration. There have been times I have thought that if I had a chance to trade places with her, to give her a chance to live in a body that works as it should while I exist in the one that she has to, I would gladly make that trade so that she could have a chance to have friends, boyfriends, an education, a husband, children, a job, grandchildren, travel, sports....everything she has to miss out on because her body won't do what it was supposed to. I have stared into her eyes, looking for the loving, intelligent soul that I believe is trapped inside and I have wondered if we will finally get to have a real conversation when we get to heaven. I hope so. It would be tragic to never have that chance. I love her and I get to say it every day. She loves me, but never gets to tell me so, so she gives me smiles, hugs and kisses instead.
I try to keep an emotional distance from what we have both lost so that I can hold myself together enough to act on her behalf. If I talk about it too much, my throat gets tight and my body trembles like I am cold and need a sweater.
I try to be okay with the life that V has, but that doesn't mean that I don't miss what it should have been. I should have been sitting at her high school and college graduation while she walked proudly across the stage for her diploma (not certificate), and I should have been taking her prom and homecoming pictures after helping her shop for a dress. I should have congratulated her on her first job and I should be looking forward to her wedding and her children. It's not fair and we have both been robbed of what should have been.
So, if you read my posts and think that you are alone feeling sad, isolated, angry, helpless or frustrated, you are not alone at all. I choose to focus on those things that I can control to maintain my own mental health and to be the best mom I can be, and I look away from all those negative feelings most of the time. But only MOST of the time.

Fitness For Health

In Rockville, Maryland, there is a fitness center unlike any I have seen or heard of. This is a place that has staff who have experience working with the special needs population and have worked collaboratively with special education teachers and occupational therapists.
Nyle, V's OT, and I visited this place today, to determine if it would be an appropriate place to work on her gross motor skills, balance, posture and motor planning. They are equipped to do these things and much more. Marc Sickel, founder of Fitness for Health, showed us around and discussed the philosophy of the program. Nyle thought it was the most state-of-the-art facility that she had seen, and better equipped than any occupational therapy clinic.
An article by Jessica Clancy that is included in the client packet we were given says this place is "customizing programs for kids who are all over the spectrum when it comes to motor skills and cognitive development." She goes on to say that clients with ADD, autism, and an array of genetic disorders have been helped here. Non-disabled clients are served here as well because the facility and staff make fitness and learning fun. Some of these kids participate in "learning through movement" to address academic skills as part of a fitness/play activity.
We will take V to see this facility in the next week or two and see how she responds to the environment and the instructor.
It is a very impressive place.
To read more about this and watch news video clips showing the facility, visit the website at FitnessforHealth.org

Keeping Up With Research

One of the ways that I keep myself informed about what is going on in the medical research that could someday help V, is through Google Alerts. Every day I get a Google Alert email that summarizes every article that mentions research related to ASD's. Today, one of the articles looks promising. I will look into it further. I have copied the text and will paste it here:

Public release date: 8-Apr-2010
[ Print | E-mail | Share Share ] [ Close Window ]

Contact: Cody Mooneyhan
301-634-7104
Federation of American Societies for Experimental Biology
New study of autism reveals a 'DNA tag' (methylation) amenable to treatment
Research in the FASEB Journal describes discrete epigenetic changes of DNA in a certain subgroup of twins and siblings with autism

A new discovery raises hope that autism may be more easily diagnosed and that its effects may be more reversible than previously thought. In a new study appearing online in The FASEB Journal (http://www.fasebj.org), scientists have identified a way to detect the disorder using blood and have discovered that drugs which affect the methylation state ("DNA tagging") of genes could reverse autism's effects. This type of drug is already being used in some cancer treatments.

"As the mother of a now 22-year-old son with an autism spectrum disorder, I hope that our studies as well as those of others, will lead to therapies that are designed to address specific deficiencies that are caused by autism, thus improving the lives of affected individuals," said Valerie W. Hu, Ph.D., one of the researchers involved in the work from the Department of Biochemistry and Molecular Biology at The George Washington University Medical Center in Washington, D.C. "Since autism is very diverse in the array of symptoms present in any given individual, it is first necessary to be able to identify specific deficits in each individual in order to design and then prescribe the best treatment. As an example of this personalized approach to medicine, we identified RORA as one of the genes that was altered specifically in the sub group of autistic individuals who exhibited severe language deficits."

To make their discovery, Hu and colleagues identified chemical changes in DNA taken from cells of identical twins and sibling pairs, in which only one of the twins or siblings was diagnosed with autism. The researchers then compared genes that showed changes in DNA tagging (methylation) with a list of genes that showed different levels of expression from these same individuals. Then the scientists studied the amount of protein product produced by two genes that appear on both lists in autistic and control regions of the cerebellum and frontal cortex of the brain. They found that both proteins, as predicted by the observed increase in DNA tagging, were reduced in the autistic brain. This suggests that blocking the chemical tagging of these genes may reverse symptoms of the disorder and demonstrates the feasibility of using more easily accessible cells from blood (or other non-brain tissues) for diagnostic screening.

"For far too long, autism research has been side-tracked by the cranky notion that it's caused by the MMR vaccine," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal. "Studies like this, which define genetic and epigenetic changes in discrete subgroups of the autism spectrum, offer real hope that effective treatments and accurate diagnosis are closer at hand."

###

Receive monthly highlights from The FASEB Journal by e-mail. Sign up at http://www.faseb.org/fjupdate.aspx. The FASEB Journal (http://www.fasebj.org) is published by the Federation of the American Societies for Experimental Biology (FASEB). The journal has been recognized by the Special Libraries Association as one of the top 100 most influential biomedical journals of the past century and is the most cited biology journal worldwide according to the Institute for Scientific Information.

FASEB comprises 23 societies with more than 90,000 members, making it the largest coalition of biomedical research associations in the United States. FASEB enhances the ability of scientists and engineers to improve—through their research—the health, well-being and productivity of all people. FASEB's mission is to advance health and welfare by promoting progress and education in biological and biomedical sciences through service to our member societies and collaborative advocacy.

Details: AnhThu Nguyen, Tibor A. Rauch, Gerd P. Pfeifer, and Valerie W. Hu. Global methylation profiling of lymphoblastoid cell lines reveals epigenetic contributions to autism spectrum disorders and a novel autism candidate gene, RORA, whose protein product is reduced in autistic brain. FASEB J. doi:10.1096/fj.10-154484 ; http://www.fasebj.org/cgi/content/abstract/fj.10-154484v1 "

So, this is just one of the 5 or more articles that come to me in an email alert each day. There are lots of studies that are being conducted every day and it makes me hopeful that at least one of these will yield some results that will help my daughter. It takes time to keep up by reading these articles each day, but don't depend on your doctors to keep up with all that is going on in research. Even the therapists that work with V, wonderful as they are, tell me that they should keep up with the latest research but aren't able to because their lives are so busy. The advantage of reading up on this yourself is that you can bring the interesting issues to the attention of those who treat you or your child or your client and see if they can find out more about it.

Friday, April 2, 2010

For Autism Awareness Week

This week there is a lot of media focus on the topic of Autism. It is a good time to learn about more resources out there than you may have known about before.
For Wrightslaw Yellow Pages for kids with disabilities, copy and paste this URL :
http://www.yellowpagesforkids.com
They list advertised services, state by state, so this can help you find the service you are looking for, where ever you are in the United States.
If you have (or are) a teen or young adult with an ASD, and work is a concern, copy and paste this URL:
http://www.jobs4autism.com
This website has the input of people on the autism spectrum who have found jobs and what their experiences have been. Some parents post as well.
Have you ever wondered if you (or your child) would benefit from a service dog? Well, there is a story about a family with an autistic child that had an elopement problem, who was helped. To read about it, copy and paste this URL:
http://www.cnn.com/2010/HEALTH/04/02/autism.service.dogs/index.html?hpt=Sbin
While our dog is not a "service dog", we did get her as a puppy with the thought that she could help us to provide a companion to V, who was not an authority figure and who could comfort her at night if she woke up and felt lonely. She has performed those jobs well, and does not react to sudden or loud movements by V since she was introduced to her at a very young age.