The NeuroDiagnostic Institute Adolescent Autism Services Unit – HANDS in Autism® Involvement towards Impact on Community Training, Transition, and Support

The NeuroDiagnostic Institute and Advanced Treatment Center, the state’s psychiatric hospital, houses a state-of-the-art adolescent autism services unit and an innovative community partnership for sustainability and prevention of re-admission. The NDI adolescent autism services unit is a collaboration of Damar Services, Inc., the Department of Psychiatry at the Indiana University School of Medicine, and HANDS in Autism Interdisciplinary Training and Resource Center, also within the Department of Psychiatry at IUSM.

Today, we are meeting with Dr. Naomi Swiezy, the director for HANDS in Autism® Interdisciplinary Training and Resource Center and Dr. Tiffany Neal, the assistant director for the HANDS in Autism Center to learn more about the role of HANDS in Autism® in this initiative.

Q: Dr. Swiezy, let’s start with you. So what is the NDI and the adolescent autism unit in particular and how did it come about?

Naomi Swiezy: The NeuroDiagnostic Institute (NDI) is an initiative that has been put together through the State. The DMHA or Department of Mental Health and Addictions is really spearheading this initiative. And the operations are run through Damar services. And then collaboratively, IU School of Medicine, specifically the Department of Psychiatry with our psychiatrists or psychologists and also HANDS in Autism are partnering alongside to assist in making sure that individuals who are admitted to the institute are able to then go forth in the community and be a successful and independent as possible.

So the folks who are being admitted are individuals who are adolescent age – 12 to 18 years old – with autism or related disorders. They also have behavioral challenges that are making it difficult for them to maintain within their own communities. They might be referred through medical practitioners, or with school staff or community providers, or the parents themselves. Ultimately, there needs to be a medical referral or a medical provider that’s making that referral. But anyone can basically indicate the need for admission.

Through Damar services and through IU School of Medicine then there’s an interdisciplinary… multidisciplinary team who determines who is most appropriate for admission. The referrals can come from all over the state. And ultimately, the idea is to be able to stabilize individuals that are having difficulty within their community; being able to conduct some assessments behaviorally and otherwise medically; and then to provide some intervention, suggestions, recommendations get that started and then promptly transition them out into the community.

Q: Dr. Neal, can you tell a bit more about the transition processes and support provided through HANDS within the community?

Tiffany Neal: HANDS is able to provide the support up to a year after they discharged so the problem is back to the community is then extended and this model by HANDS been able to provide that added support

So it’d be a tiered support depending upon what level of intensity of services they needed in the unit or what’s anticipated as they go back out to the community so everything from quarterly check-ins or working with the team to more intensive services where we’re delivering some of the intervention and training alongside the community team.

But there’s discharge planning that occurs about 30 days until they’re released, where we start engaging the team and we really engage the team pre-admission but then we’re able to connect and confirm that team or fill in gaps for the team. And then as the patient discharges or the student discharges. There’ll be a two-day community training where we’re able to provide context and make sure that any of the support then, and treatment plans that were implemented on the unit are transferred out or are set up for that transfer. And we’re able to meet with the team prior to and then as the patient is discharged the day that they’re back in the community, we are able to do some direct training and more hands-on coaching with the patient and the core team that’s been identified within the community.

Q: Are there similar models already available in the States?  What inspired you to have such a multifaceted approach?

Naomi Swiezy: So there definitely there, there definitely is some precedent for doing similar kinds of models but not very many of them across the country. But some of us have worked in programs that have kind of that similar ability to be able to interface with the community until folks are able to get into the unit, and then, you know, work with them on the unit and post discharge for a period of time. So that is a model that some of us have worked in prior. So that was one thing that inspired.

But then also just the need of the community so what all of us as providers have seen time and time again is that institutionalization and sending people away somewhere is not a fix. You’re obviously in a very different environment, a very different context and behaviors and the way that the individual is responding within that context, may be very different than how they do in the community. So the most effective means is to really understand what’s going on in the community; and what the environment is like that’s supporting them out in the community, using that to help to inform some of the goals and some of the strategies are implemented on the unit with keeping in mind where they’re going back to. And then ultimately providing that support out in the community so that any changes that are made, or any of the recommendations are able to be implemented and sustained over a period of time. Because what we do see is that there is that, you know, kind of “open door”, or “swinging door,” that occurs a lot as folks are not being as successful as they could in the community so then they’re sent somewhere. They spend a period of time. And then folks are, you know, accepting them back, but really, not any further tooled and understanding, most effectively how to work with the individual once they’re back, and to again, maintain some of those games.

So it is a very unique format to be able to build on the skills that all of us have for Damar who’s, you know, run a wide range of intensive services prior and has, you know, just networks across Central Indiana, in terms of a whole range of different levels of services. Our Psychiatry Department inclusive of HANDS that works alongside of families and schools across the state. It’s just really been a very nice blend to begin to coordinate those emphases.

Q: I’d like to go back to the topic of referral and key reasons for admissions. So what would determine the decision to admit a person to the unit?

Tiffany Neal: Dr Swiezy was mentioning that it’s individuals that:

  • are 12 to 18 years of age that have challenging behavior,
  • diagnosis or eligibility of autism spectrum disorder or related disability,
  • and really have IQs or cognitive abilities within the full range so down to 40 and then more severe up through average range.

So it’s a pretty wide range of patients that are potentially being served. Most of them are having challenges, and, you know, either in resource access or again as Dr Swiezy was mentioning recidivism between facilities and no one taking that time to really stabilize and do an appropriate assessment and and have that more full community team approach, where they’ve seen a number of providers or they’ve been involved in a number of systems and settings. And as we know, autism is oftentimes excluded from a lot of the community services, the wraparound care and the CMHs and, you know, other service agencies are unable to service individuals with autism and so these individuals are left without a kind of service entity that can do that, that primary kind of stabilization and assessment and really looking at their treatment overall to transition back out to a team.

Naomi Swiezy: And I think what’s really unique too as well, you know that intervention is occurring on the unit. That is when folks are also being able to access a wide variety of resources through HANDS in Autism. And through affiliation with the neuro diagnostic Institute, so that folks can begin that learning process and not waiting until the individual is ready to come back. But they can access all kinds of modules and resources and really get to know us as we get to know them as well. And then it really helps to facilitate that relationship building and understanding and speaking the same language so that then when the individual comes back to the community we’ve built those relationships and we’re ready to get to work to help to maintain them out in the community.

Tiffany Neal: Building upon the team piece I think it was helpful. And what Dr. Swiezy was mentioning (as you asked) in regards to the team component because I think these kiddos or patients are also ones that have cycled through either a number of providers or a number of settings within the school system or a number of, you know, professionals within the community and even sometimes placements. If it’s not, you know, if they’re not so worth their primary caregivers. So again, I think that having that honest discussion and having the collective team involved through the partnership sets the stage for more of that dialogue and identifying the gaps to set their course a bit differently and then access to resources, build that foundation among whomever is identified as the core team to help foster kind of that transfer and discharge as they go back out in the community.

Thank you for your time. For more information about the NDI, please visit HANDSinAutism.IUPUI.edu/ndi

Online Safety

What are some considerations for online safety?

  • Individuals with ASD are just as interested, if not more, in the Internet than their peers due to the access to information and as a means for social communication (Autism Speaks, 2011; Benford & Standen, 2009). Online communication also helps reduce discomfort and anxiety faced by individual with ASD (Bagatell, 2010).
  • Individuals who have difficulty learning or have a disability are 16% more likely to be persistently cyberbullied over a long period of time (Department of Children, Schools and Families, 2008).
  • Individuals with ASDs are more likely to develop compulsive Internet usage than
    individuals without ASDs (Finkenauer et al., 2012).

Source: https://ed-psych.utah.edu/school-psych/_documents/grants/autism-training-grant/Internet-Safety.pdf

Teens and Screens: The Good, the Bad and the Ugly

Additional Resources:

Technology

What Are Assistive Technologies?

Assistive technology (AT) device is “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities” (Technology Related Assistance to Individuals with Disabilities Act of 1988). Such technologies can be “high” or “low tech” (from canes to voice recognition and speech generation devices). More information on different types of AT can be found at https://at.mo.gov/information-resources-publications/documents/Autism.pdf

AT for Communication Skills

Some individuals with ASD may be non-verbal or have difficulties understanding social cues or conversation. Speech generating devices may help such individuals. This can be a standalone device or specialized software installed on a tablet of phone. The NIDCD at the NIH has more information.

AT for Social Skills

Social skills is often a challenge for individuals with ASD. There are many applications to help individuals with ASD develop social skills that range from teaching facial expressions, to academic and social learning, to helping deal with stress and maladaptive behaviors. Informing Families has more examples.

Daily Living Skills

Daily living skills, such as hygiene, organization skills, and recreational skills, are important for individuals with ASD to master on their path towards independence. You can find some examples at wikibooks.

Where to Find Information on Such Devices

You can check out the following resources:

Sexual Health Class Research Survey

Individuals with ASD rarely get sufficient and/or reliable information about healthy sexual behaviors from traditional sources, like at school or from parents/caregivers, which often results in an increased risk of becoming victims of sexual crimes or perceived offenders (Brown-Lavoie, Viecili, and Weiss, 2014). Reviews and research related to the sexual health curriculums used within schools or educational settings for individuals with ASD is sparse with some indication of the absence of any existing or adapted curriculum in regular use. Removal of these students from sexual health classes means they are left to obtain information from unmonitored sources.

This brief survey is designed to gain insight from a variety of stakeholders (i.e., family members/caregivers, teachers, school admin, or individuals with a disability) regarding sexual health knowledge and the programs provided within an educational setting for students with disabilities.

As a thank you for your participation, you will receive a PDF info sheet with practical strategies for providing resources and skills teaching materials related to sexual health as a step towards preventing sexual abuse or victimization of individuals with disabilities. Please consider sharing this survey with friends and colleagues alike.

Please contact Naomi Swiezy, Ph.D., HSPP, Director, HANDS in Autism® Interdisciplinary Training and Resource Center at nswiezy@iupui.edu or Tiffany Neal, Ph.D., Assistant Director, HANDS in Autism® Interdisciplinary Training and Resource Center at nealtiff@iupui.edu with any questions, concerns, or additional comments.

Applied Behavior Analysis (ABA)

On this page, you can explore the following topics (click on the topic of interest):

What is ABA?

Applied Behavior Analysis, or ABA, is a research-based philosophy of working with individuals of different abilities, not just individuals with ASD. ABA encompasses a range of strategies and methods based on standard behavioral principles designed to address reduction of behaviors by encouraging positive or desired behaviors and discouraging negative or unwanted behaviors in order to improve a variety of skills. Behaviors are considered to be a form of communication that can be addressed by teaching appropriate skills to support the reduction of undesired behaviors across settings.

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Examples of ABA methods include, but are not limited to:

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  • Incidental Teaching: Creating a learning environment based on an individual’s interests or motivations

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  • Social Stories™: Using words and/or pictures to describe what to do in various situations that may challenge or provoke anxiety within an individual (developed by Carol Gray)

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Additional Resources

Autism Speaks: Applied Behavior Analysis (ABA) www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba

Behavior Analysis Certification Board (BACB): About Behavior Analysis www.bacb.com/about-behavior-analysis/

HANDS in Autism® Interdisciplinary Training & Resource Center: Applied Behavior Analysis (ABA). What is it? HANDSinAutism.iupui.edu/autism.html 

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