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Service Options

Currently, I am still working on a complete list of services that I will provide and the list of funding sources I will accept. My paperwork with insurance providers is still being processed and I hope will be completed soon.  Below I will outline some basic info about behavior analytic services, and towards the bottom of the page will be services I am offering at this time. Additional services will be added soon!

 

Typically, BCBAs conduct what is called a Functional Behavior Assessment (FBA) before talking to parents/guardians about therapy goals.  The FBA consists of indirect assessments (questionnaires, screening tools, etc) that are given to the parent/guardian and direct observation of the person services are requested for, in environments and times that are more challenging for that person.  This allows the BCBA to collect behavior data so that the reason that the behavior occurs can be analyzed.  In behavior analysis, this is called the function of the behavior.    

In behavior analysis, there are 4 functions of behavior:

- Attention (social interaction), Tangible (access to an item), Escape/Avoid (either to get away from or avoid something, like school work or a chore, or a person, such as a teacher),  or Sensory/Automatic (an innate need to do a behavior that occurs even when no one is around).

After a FBA is conducted, what the assessment indicates is the function (purpose) of the challenging behavior is, then a Behavior Support Plan (BSP) can be written up. The BSP outlines skills the individual needs help with and ways to support these needs with individualized treatment plans.  

 

Therapy will use targeted teaching skills (also called treatment plans).  Ongoing behavior data will be collected every therapy session so that outcomes of your child's time can be accounted for and progress changes are documented for comparison over time.  When therapy begins, you would want to see progress made from where your child was at at the time of the initial assessment.  How quickly your child makes skill gains is not something I can fully predict but typically gains should be seen every month.  If that isn't happening then the teaching approach and goals need to be reassessed by the BCBA.  

When are behavior analytic services not the best option?

Sometimes an individual's challenging behavior occurs for reasons that are not best served by behavior analytic services.  An experienced BCBA should be able to identify when that is the case and should give you a referral list of alternative services.  At times, the individual's needs may indicate that some support needs are targeted with behavior analytic approaches and some are targeted by other community providers.  

Here are a few examples of this:

1.) The child exhibits challenging behaviors that appear to be related to prior trauma.  

                      (May need a trauma-informed mental health counselor)

2.) The individual exhibits challenging behaviors that appear to be related to mental health needs.

                      (May need a psychologist and/or psychiatrist)

3.) The individual exhibits challenging behaviors that occur during school tasks that are difficult for them and are due to a specific learning disability (SLD).

                       (May need a reading or math specialized tutoring)

4.) The individual seeks out sensory input on a regular basis or exhibits challenging behavior in the presence of certain sensory stimuli.

                        (May need an occupational therapist)

If the individual has one of the above support need indicators but also could use help with functional communication, social, or adaptive life skills (aka independent life skills) then a BCBA could target these support needs and another community provider may provide therapy for the other need(s).  Most families find that an interdisciplinary support team is the best way to fully support their child.  No one approach can capture all the ways an individual grows over a lifetime!

Services I am currently offering:

I am a Missouri First Steps (FS) provider.  My title with FS is an ABA Consultant.  Children I provide support for with FS are referred to me by FS service coordinators.  Currently, I serve children enrolled in FS in St. Louis City, St. Louis County, South County, and St. Charles.  I have been a FS provider for a little over four years.

I have provided services to adults through Missouri Medicaid Waiver funding, with the Missouri Department of Mental Health (DMH).  My provider enrollment paperwork with DMH is under transition so I currently have my services w/DMH on hold until this is completed.

An FBA is necessary before behavior analytic services can be started and is quite costly.  It is in the family's best financial interest to get this funded through insurance.  A cash option is one we can discuss if families don't want to wait for the time it will take for insurance providers to process my paperwork but that is completely up to the family.  You may contact me to discuss this if you would like.

A quicker and cheaper FBA alternative: Behavior Support Needs Workup

I have talked to several parents over the years and have heard their stories of support need failures by a variety of community providers.  Some of this seems to have occurred because the age of the child.  Therapy options have drastically changed over the last 20 years.  If a child is in their late teens or older, they may have not interacted with community providers who are educated in more interdisciplinary methods.  In all honesty, those same providers may have a much different approach today than they did 10+ years ago.  

The parent may have already had multiple expensive assessments and put in hours with community providers.  So the parent may assume they have a comprehensive understanding of their child's needs.  Yet, the fact that they wish for better support for their child also indicates that maybe their child's needs and learning profile could use a fresh set of eyes.  That's where the Behavior Support Needs Workup (BSNW) comes in.

The BSNW is my personal assessment tool.  It is not provided by other BCBAs.  This is a cheaper and quicker assessment than the costly and longer process the FBA has.  The downside to the BSNW is that it's cash only as insurance providers will not cover it.  The upside is that it's affordable and can be used to help inform the workup of a FBA.  

What the BSNW provides the parent/guardian:

1.) The BSNW could provide information that may help clarify why the child has struggled with social situations, school work, and independent life skills.

2.) The BSNW will inform the parent/guardian about what their next steps could be, in order to pursue appropriate supports for what is specifically challenging for the child.

3.) The BSNW can be used to inform a formal Functional Behavior Assessment (FBA) should the parent/guardian wish to obtain one.  If the parent/guardian already has a current BSNW on file, this could be given to another community provider who is doing other assessments and help speed up the process other assessments may take.

4.) The BSNW can be shared with the child's community support providers so they can quickly review your child's specific profile needs.  This should help enhance interdisciplinary discussions about your child's support needs.

BSNW Documentation:

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- I will need your child's school records.  Grades over the last couple of years is a good starting point.  If there are more in-depth educational records on file I may want to review these as well.

- I will need you to fill out a medical history form.

- I will give you assessments that will give us a general understanding of your child's: 

        A.)  communication, social, adaptive (independent life) skills.  

        B.) psychological flexibility profile, based on what Acceptance and Commitment Therapy defines as a flexible mindset

        C.) sleep quality - if parents indicate this is a concern

        D.) quality of life - what community interactions do they currently have, how is their overall well-being, are they achieving 

                                    their vision of the "good life"

 

BSNW Report: 

I will write a report based off of what you provide me.  It will state where your child seems to be at right now, in the domains covered by the assessments, and what could be better supported.  Additionally, I will list my suggestions for services the parent/guardian could pursue with additional community providers.  Due to my personal experiences, I will able to outline where these services would best be accessed: medical, psychological, educational, etc.   

Services after the BSNW:

If the parent/guardian wants behavior analytic services, a FBA still must be conducted.  I would be willing to do this at a reduced rate, since the BSNW was already done.  

 

This reduced rate would have to be in cash as insurance will not give a reduction to FBA rates.  Depending on the FBA insurance provider, they may offer FBA reimbursement for the length of time it takes to complete.  Therefore, if that is the case, it may only take a qualified health professional to write up the FBA, after the observation assessments completed, 2 hours to do instead of 4 hours, because they can use the BSNW to inform their FBA.  I cannot confirm that will be an option so please keep that in mind if healthcare savings is a family priority.

Costs for BSNW:

I am offering a basic BSNW cost.  Additional costs may be added if the parent/guardian requests more time to do an in-depth review of medical, psychological, educational, or therapeutic documentation, or if the parent would like other assessments to be conducted that are not included with the basic BSNW.

The basic BSNW will include the time to review 4 assessments the parents/guardians completed, a quick review of any of the child's medical, psychological, educational, or therapeutic documentation that is provided, time to write up the official report, and a 30 minute meeting with the parent/guardian to go over the BSNW report.

The basic BSNW will cost $200.  

Each additional assessment will vary in cost, depending on if the assessment is indirect (done by the parent/guardian) or directly (with the child).  These could add anywhere up to $15 to several hundred (if an FBA is requested).  

Advocacy Services:

The importance to advocate for my clients is a mindset I already have.  And I do this on a regular basis with family members and community providers.  Sometimes, families find themselves in difficult situations with other community providers who they feel do not fully understand their child's needs.  If I have done a BSNW for your child or have been consulting with the parents/guardians about their child's needs, I may feel informed enough to be an advocate for your child in an upcoming meeting.  If you would like to talk about me providing advocacy services for your child, contact me and we can discuss a reasonable way to use my services that is the most cost-effective approach for your family that I can provide.

Reach out to me!

If any of the above sounds like a service you would like to discuss further with me, please email me!  

My email is: therapy@julielpreuss.com

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