Tuesday, June 21, 2011

Expanding Services


Today I met with a family from Somalia who came to seek my advice on how to support their 4 year old son in school.  The principal of the school feels that the child has "borderline autism" and the school may not be able to provide the support the boy needs.  After probing quite a bit and getting some background information, it sounds like there are many variables that could account for some of his delays academically and with his speech.  They said they had him screened for autism almost a year ago, and no diagnosis was given.  The principal would like to see the family get a second opinion, and I advised the family that it couldn't hurt to either rule it out or rule it in, for their own knowledge, but they should be very careful with how they disseminate that information, as it could cause him to be viewed and judged based on his label, not on his skill repertoire and abilities: it should not matter whether he has autism, what matters is how he is functioning relative to his peers, and his success in the classroom.  They asked what they could do in the meantime, and I suggested they have consistent contact with the school teacher, and the principal so she does not feel as if she is being left out, and target areas as needed and proactively as possible.  The break time between terms would be an ideal time to help him in areas he may be lacking.
What was positive was that the family was not plagued and concerned with the possibility of being diagnosed with autism, but instead want to use this knowledge to provide support where it is needed.  This meeting sparked an already determined interest in understanding diagnostic criteria, and how this information is then used to guide families towards resources they may need.  Perhaps if there is more awareness surrounding appropriate and accurate diagnosis while taking into account cultural differences and practices, maladaptive behaviors and developmental milestones can be targeted earlier, increasing likelihood for success throughout life.  Pooja and I also had the chance to take a closer look at specific clinical practices for specific clients, specifically shaping skill acquisition for a child with cerebral palsy.
We developed "First, Then" visual aides, and worked with staff on how to make access to powerful reinforcers contingent on appropriate responses.  Upon speaking in depth with the trainers at Kaizora, a targeted clinical training need during this trip will be the principles of reinforcement, planned ignoring and extinction.  Subsequent to this, in an effort to provide staff with more tools in order to make data based decisions, further training will be done in how to conduct preference and reinforcer assessments, and how to use this data to support skill acquisition.
This has further implications to create for Global Autism Project a structural training module and protocol for use at each site, based on the BACB's BCBA task list as well as personalized systems of instruction and inter rater reliability.  Another area of need appears to be logistics in terms of being able to provide services to everyone who needs them in all areas of Nairobi.  There are many families that have come for assistance, however logistics in terms of distance, transportation, etc, prevent them from being able to receive services consistently.
- Emily

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