ABOUT

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.

Tuesday, November 16, 2010

More Confirmation that Hope is Justified

I have copied and pasted this article that came to me today through my Google Alerts about research studies on ASD's. It brought tears to my eyes to read about such encouraging progress toward the possibility of real, permanent improvement for those affected by ASD's.

Researchers Use Skin Cells to Study Autism in Petri Dish
November 15, 2010 at 4:00 AM by Gant Team · Leave a Comment
By Barbara Kennedy, Penn State
A team of researchers has used stem cells taken from the skin of patients with Rett syndrome — the most physically disabling of the autism disorders — to replicate autism in the lab and to study how the disease affects brain cells. The team’s findings, to be published on Nov. 12 in the journal Cell, reveal disease-specific cellular defects, such as fewer functional connections between particular neurons, and demonstrate these defects are reversible. The results raise the hope that, one day, autism may become a treatable condition.
“The beauty and excitement of this new work is the demonstration that we can use patients’ skin to study autism,” said Gong Chen, associate professor of biology at Penn State and one of the study’s authors. Before this research, scientists had been limited to studying the brains of people with autistic-spectrum disorders via imaging technologies or with postmortem brain tissues. “The fully-functional neurons derived from skin are no different in their electrophysiology properties from neurons isolated from the brain. I believe this study, together with other recent studies, will provide hope for patient-specific stem-cell therapy in treating some diseases that currently are difficult to cure.”
Rett syndrome primarily affects girls, and the symptoms often become apparent just after they have learned to walk and say a few words. Affected children regress into an infant-like state, losing speech and motor skills, and developing stereotypical movements and autistic characteristics. “Mental disease, and particularly autism, still carry the stigma of bad parenting,” said Alysson Muotri, an assistant professor in the Department of Molecular and Cellular Medicine at the University of California, San Diego School of Medicine, and one of the study’s authors. “We show very clearly that autism is a biological disease that is caused by a developmental defect directly affecting brain cells.”
Because almost all cases of Rett syndrome are caused by a single mutation in the MeCP2 gene, the team took skin biopsies from patients carrying the mutated gene. By exposing the skin cells to four reprogramming factors, they “turned back the clock,” triggering the cells to look and act like embryonic stem cells. Known at this point as “induced pluripotent” stem cells, the Rett-derived cells were indistinguishable from their normal counterparts.
It was only after the team had patiently coaxed the stem cells to develop into fully functioning neurons — a process that can take up to several months — that they were able to discern differences between the two. Neurons carrying the MeCP2 mutations had smaller cell bodies, a reduced number of synapses and dendritic spines, and electrophysical defects, indicating that things start to go wrong early in development. “It is quite amazing that we can recapitulate a psychiatric disease in a Petri dish,” said author Fred Gage, a professor in the Salk Laboratory of Genetics and holder of the Vi and John Adler Chair for Research on Age-Related Neurodegenerative Diseases. “Being able to study Rett neurons in a dish allows us to identify subtle alterations in the function of the neuronal circuitry that we never had access to before.”
The team also found that insulin-like growth factor 1 (IGF-1) — a hormone that has a role in regulating cell growth and neuronal development — was able to reverse some of the symptoms of Rett syndrome by restoring proper function to Rett neurons grown in culture. In summary, they found that IGF-1 treatment increased the number of synapses and spines, reverting the neurons to a closer-to-normal stage. This finding suggests that autism is not necessarily permanent and could be at least partially reversible. The new research also opens up the prospect of developing a drug treatment for Rett syndrome and other forms of autism. “Rett syndrome is sometimes considered a ‘Rosetta Stone’ that can help us to understand other developmental neurological disorders since it shares genetic links with other conditions such as autism and schizophrenia,” said author Maria Carol Marchetto, a postdoctoral researcher in the Laboratory of Genetics at the Salk Institute.
Along with Chen, Muotri, Gage, and Marchetto, Gage, and Marchetto, other researchers who contributed to the work include Cassiano Carromeu, Allan Acab, Gene Yeo at the University of California, San Diego; and Diana Yu and Yangling Mu at the Salk Institute for Biological Studies.
This work was supported by the Emerald Foundation Young Investigator Award, the National Institutes of Health through the NIH Director’s New Innovator Award Program, the California Institute for Regenerative Medicine, The Lookout Fund, and the Picower Foundation.

Monday, November 15, 2010

Jill's House

There is a new respite resource in Northern Virginia. It is called Jill's House and sounds very impressive from what I have heard and read. Unofficially, I have heard that they are working with other area churches to help set up other similar centers and outreach programs to families that include a disabled child.
Here is a Washington Post article about Jill's house:
copy and past this URL to read more:
http://www.washingtonpost.com/wp-dyn/content/article/2010/09/29/AR2010092903265.html

In addition, you can go to Jillshouse.org and visit the website where you can take a video-tour of the facility and listen to some of the families that are served. I was very impressed by the facility after watching the video-tour. It certainly is well-designed and welcoming and is open to families of any faith (or no religious affiliation at all).

I do not belong to the McLean Bible Church but know people who do. They have shared with me that the minister has a disabled daughter and she was the inspiration to begin an outreach program to help members attend services while the children received the care they needed. This respite center grew from that original outreach program. I hope the idea spreads!

Monday, September 20, 2010

Emergency Preparedness

Dennis Debbaudt is a name that appears frequently in information regarding training about Autism to first responders in emergencies.

There is a document that contains some suggestions about how to prepare for an emergency ahead a time. To read about these suggestions, go to this link. I found that it contained some information that I was unaware of. For example, did you know that some communities have a 911 special needs database? I didn't. You can provide information about the person in your home with special needs in advance of an emergency in case you are unable to communicate the information yourself. Did you know that there are decals for your car and home that let first responders know that someone with autism may be present? I didn't.

Copy and paste this URL to read more:


http://www.autismriskmanagement.com/documents/autism_emergency.pdf

Sunday, September 19, 2010

Are Law Enforcement Officers Trained to Respond to Citizens with ASD?

I am curious about what resources are provided to those people who work in our community to respond to emergencies. Do they know the best ways to help our "special" citizens, or might they accidentally make things worse because of lack of training or knowledge?

I am trying to find out the answers to these questions. I always find the internet to be one good source of information and an easy place to begin finding answers.

Here is one article about some local programs:
Copy and paste this URL to read about some Maryland and Virginia counties in the D.C. area:
http://technorati.com/lifestyle/family/article/law-enforcement-training-for-autism-related1/

Here is a link to information about training for first responders:
Copy and paste this URL to read about this training program :
http://www.leanonus.org/trainings.html

This link is about a conference in North Carolina that was held for state law enforcement after a man with autism died while in police custody.
Copy and paste this link to read about it.
http://asa.confex.com/asa/2006/techprogram/S2232.HTM

This newsweek article relates several specific instances of misunderstandings that have happened when law enforcement came into contact with autistic individuals and explains how organizations and concerned citizens are trying to provide better information to officers through training.
Copy and paste this link to read more about it:
http://www.newsweek.com/2010/07/08/is-sitting-while-autistic-a-crime.html

This link is to the Autism Society and is about pamphlets that they offer to assist first reponders and law enforcement.
Copy and paste this URL to see this information:
http://www.autism-society.org/site/PageServer?pagename=research_safeandsound_firstresponders

So, from my internet search, I am still not clear on what, if any, training has been provided to Maryland state officers, Montgomery county officers, or the city forces of Germantown or Gaithersburg where we would be mostly like to encounter the police. Looks like more research is needed. At least I now know that some of our country's jurisdictions are addressing this issue.

If you know more about this topic, please add your comments.

Postscript: I learned from Craig Schultz of the Autism Socieity of America, that trainings to Montgomery County, MD and Rockville, Md police have been provided by the ASA. Also, Maryland State police have had training in general mental health issues, but not specifically ASD's or developmental disabilities, but that training could be considered in the future.

Promising new drug test for symptoms of ASD

Copy and past this URL to read the full article about this new drug test:
http://www.technologyreview.com/biomedicine/26284/?p1=A2&a=f#afteradbody

This is one that I would ask my daughter's doctor to look into. Here is just an the beginning of the article:

A Drug Shows Promise in Autism
A chemical that alters chemical signaling seems to ease anxiety and other symptoms.
By Karen Weintraub
WEDNESDAY, SEPTEMBER 15, 2010


Though the research is still preliminary, scientists appear to be closing in on a molecular explanation for at least some cases of autism. Research in lab animals, cadavers, and now in a small clinical trial in children seems to support the idea that autism is caused by a lack of chemical regulation in synapses, the junction between brain cells.


Alleviating autism: A drug called arbaclofen (its chemical structure is shown above) appears to ease anxiety and some other symptoms in a small study of children with autism.
Credit: Seaside Therapeutics
The latest evidence for this comes from a clinical trial of 25 autistic children ages six to 17. The trial was conducted by Seaside Therapeutics of Cambridge, Massachusetts. In unpublished data released last week, the company says the children seemed to respond well to the drug arbaclofen and suffer minimal side effects. Arbaclofen is related to the drug baclofen, a commonly used muscle relaxer and antispastic agent. The children took the drug for eight weeks, and most saw significant improvements in measures of irritability and communication, two common problems in autism.

The finding is considered preliminary because the study was not placebo-controlled, meaning scientists couldn't compare children taking the drug to those taking a placebo. This is especially important in studies of autism because many of the tests used to assess patients are subjective, including behavioral evaluations from parents and clinicians, says Jeremy Veenstra-VanderWeele, assistant professor of psychiatry, pediatrics, and pharmacology at Vanderbilt University. About a half-dozen of his patients were involved in the trial.

IAN Topic on Bullying of ASD children

As I have mentioned in a previous posting, IAN, is a helpful website and here is an article relating to IAN on the topic of Bullying at school for ASD kids.

Find the article by copying and pasting this URL;
http://www.crestonnewsadvertiser.com/articles/ara/2010/09/16/8049210103/index.xml

More information on this topic can be found on the IAN website

Saturday, September 18, 2010

Emergency Resources in the Community

Yesterday, I held a training on behavior management and safe strategies for V's personal support staff. We have some new staff who have been trained by a local agency and their strategies and responses were not exactly on the same page with the staff who have been with us longer. My hope was to get them all using the same strategies and working well together with each other when they take V into the community. Although V has 2:1 staffing for community time, one of the staff mentioned during the training that she thought there may be circumstances where she would call the police for assistance. This has never happened in all of V's life and I have never had to give consideration as to what consequences such a action might have for all parties involved.

The trainer informed the staff that they had more and better training on how to manage V than the police have, and that such an action would probably result in V being placed in handcuffs and taken somewhere in a police car, and this would not be the best solution to the problem.

The fact that someone on staff was even thinking of this as a possibility concerned me enough to follow up on this topic with a personal friend who is the captain of the local police station. I asked him what would happen if my staff called the police while out in the community with V in a situation they did not feel they could safely handle. He confirmed what the trainer had told my staff, that they would probably put her in cuffs and take her to the emergency room in the police car. He was unfamiliar with the basket hold or other safe restraints and escorts that my staff have been trained in, and so this is probably the case with the officers on the city force.

He suggested that I call the community services division of his city and speak to Crystal,the director for guidance. I called her right away and spoke to her at length about my issue. She was not sure about the best recourse in such a situation, but suggested that I contact the Mobile Crisis team at the Crisis Center for the county department of health and hygiene.

I followed this advice and explained my situation to Beth at the Crisis Center. She explained to me that the people at the Mobile crisis Team were trained to talk to Verbal individuals who were in a mental health crisis, and that the team had a hands-off policy. When they respond to a crisis they bring police with them. She thought that a better resource, although not a perfect option, was to call the police non-emergency number and request a CIT officer, who is someone who has been through a 40-hour advanced mental health training and who she thought may be more likely to listen to the recommendations of the support staff.

Basically, my conversations made the Mobile Crisis Team aware that there is a population of people in the community that they are not prepared to serve. I wonder if an awareness of a gap in services might lead to some action to fill that gap.

My friend, the police captain, sent a follow up message to see if his referral had been helpful, and I filled him in, at the same time providing the contact information for our trainer in case he ever feels it would be appropriate to provide training to his officers for how to best manage citizens with autism or developmental disabilities in the community who are agitated and not necessarily able to talk it through.

I learned a lot through the question raised by my staff about using emergency resources in the community, and I have a lot more to learn to feel that I have a good solution for my staff in these situation. I need to provide them with guidelines and emergency contacts for exactly this kind of scenario, although, to date, they have never been unable to resolve a problem in community without additional help.

They have the contact information for my husband and I, doctors, therapists, etc... but what I think they actually want is just an extra strong body to assist in the moment. Since my husband and I are not always close by, I could give permission for them to call an off-duty staff member for assistance, since those people would have the necessary training and experience. I can provide the non-emergency police number for a CIT officer, although I don't know if that would be more helpful or harmful, and usually V calms down before anyone else can actually get to the location she is at anyway.

If anyone knows of any better solutions to these situations, please post your comments.