Providence’s Merrymeeting Center for Child Development

Providence’s Merrymeeting Center for Child Development (MCCD) was founded in 2000 as a Maine Certified Special Purpose Private School by our family, working with public educators, State of Maine officials, and a corporate partner, Providence Service Corporation (stock symbol PRSC.)

MCCD’s mission is to serve children with autism and similarly-presenting disabilities utilizing evidence-based practices, and to provide a student-centered continuum of services in the most inclusive, effective settings.

Merrymeeting Center is unique in its service to families in several ways:

• Focus on Families:
MCCD was co-founded by a family who has twins with autism.
• “One Stop Shopping”:
MCCD is not only a school, but a comprehensive continuum of services resulting from the confluence of numerous public funding sources.
• Science-based:
MCCD utilizes education and treatment methods that are empirically validated and data-driven.
• Quality of Life:
Goals and objectives are selected collaboratively with input from the client and family from a global, life long perspective. As well, objectives are pursued that help the individual benefit from health care, dentistry, grooming (e.g., haircuts), leisure activities, community inclusion and participation in spiritual worship.
• Meeting the Family Where They Are:
Family Independence training based upon the pragmatic application of ABA principles in the home, school and community is available upon request, but is not required of families who may not yet be ready for this.
• Staff Training and Supervision:
MCCD currently has the highest concentration of Board Certified staff in the State of Maine engaged in the direct instruction of children with autism.
• Data Analysis and Rate of Learning:
Data are reviewed weekly, and adjustments are made to achieve high rates of learning.
• Supported Inclusion and Transition Services:
MCCD staff can continue to provide support for the child in public or private school on a subcontracted basis until the school is prepared to assume that responsibility.

Focus on Families: When our twin boys were diagnosed in 1995, there were 158 Maine children identified as having autism (Child Count). The GreenHouse Nursery School in Milford was the only Maine program known to be offering education and intervention based upon applied behavior analysis, and that was several hundred miles from our home. Overwhelmed by the twins’ needs and increasingly disruptive behavior, we faced three choices:

• Uproot the family and move to another state where there were more services. This was problematic, since the out-of-state ABA providers had long wait lists. As well, we were small business owners, and our customers were near our home.
• Conduct the entire early intervention program ourselves. This seemed impossible, given that each child required roughly 30 hours a week of services, and we had no training.
• Start a school and treatment center, procuring the expertise needed to help our sons and others.

While we considered our alternatives, we accepted services from the Lead Education Agency subcontracting a group that was conversant with ABA, but focused almost exclusively on utilizing discrete trial training (DTT). At the time, we were unaware that over-reliance upon DTT and compliance training could actually shape up escape and avoidance behaviors in our children and that is exactly what happened. Quality of life eroded rapidly, as did the rapport we had with the service provider. Interfering behaviors reached such a level of acuity by the time the boys turned four that the provider sought to transition the boys to another setting: residential placement 350 miles away. Given the high level of aggression, property destruction and self injurious behavior the boys now presented with, the LEA agreed a less restrictive setting was no longer a choice.

Faced with imminent residential placement, the LEA, State of Maine, Providence Service Corporation and our family engineered a way to bring effective,evidence-based education and behavioral services to our home and community: Merrymeeting Center. It is in part because of this journey that MCCD remains acutely focused not only on the needs of the child with autism, but the context within which families seek to overcome what is likely the most significant challenge of their lives.

“One Stop Shopping”: Our early journey to help our sons revealed a service system that was fractured, inefficient, and often counter-productive. Each domain (OT, PT, speech, academics, community inclusion and parent training) sported its own case manager, service plan, philosophical orientation and protocols. It became incumbent upon us as a family to case manage the case managers. As well, we invested an extraordinary level of resources in service coordination and transportation to various therapies. Using a wraparound process, MCCD is able to combine IDEA-mandated “free and appropriate education” guided by the IEP, with what are traditionally goals and objectives pursued under “related services” or non-academic individualized service plans (ISPs). MCCD consolidates the IEP and ISP under one unified plan utilizing consistent staff, oversight and protocols.

Science Based: It became clear to those who ultimately fund Merrymeeting Center that parents and professionals sometimes value “choice” over “efficacy.” Faced with a diagnosis of autism, parents and professionals confront a staggering number of “options” in a single internet search. Each “choice” is passionately proclaimed as effective by those who promote it. This vast quantity of un-differentiated information can overwhelm families at a time when we are most likely in the throes of grief over the diagnosis of autism. The stress of grief, confusion, fear, and conflict with funders can combine to add marital strain, depression, financial stress and mental health risks to the family’s challenge.

Merrymeeting Center is therefore committed to objectively basing treatment decisions on empirical, data-driven, peer-reviewed science. Although science tells us applied behavior analysis currently offers individuals with autism the highest potential for a self-sufficient and rewarding life, Merrymeeting Center remains open to what peer-reviewed science will continue to reveal to us in the years ahead. One way Merrymeeting does this is through strong support of the Association for Science in Autism Treatment (ASAT.) ASAT’s mission is “to disseminate accurate, scientifically sound information about autism and treatments for autism, and to improve access to effective, science-based treatments for all people with autism, regardless of age, severity of condition, income or place of residence” www.asatonline.org .

Merrymeeting Center is also proud to include among our staff several individuals who served on the MADSEC Autism Task Force. MADSEC is the acronym for what is now the Maine Administrators of Services for Children with Disabilities, a membership organization comprised of Special Education Directors. In 1997 – 1999, MADSEC convened the Autism Task Force to “perform a detailed analysis of methodologies with which to educate children with autism” from a science-based perspective. (MADSEC, 2000). The MADSEC report is available online at www.madsec.org/docs/ATFReport.pdf.

Finally, Merrymeeting Center also relies upon the New York State Department of Health Clinical Practice Guidelines, which was formulated based upon the scope and quality of scientific research.

On occasion, families approach Merrymeeting Center requesting to try an intervention that is unproven or has been disproved by the peer-reviewed literature. After reviewing the existing literature as a team, families may accurately point out that while the studies do not support the intervention in question; it has not been tried with their specific child. In these cases, Merrymeeting Center is open to approaching the theory of the intervention’s effectiveness using single-case experimental design. Particular care is taken with the informed consent process to ensure the family and others concerned are well aware of the experimental nature of the work. Results of the experiment are reviewed as a team, and compared to decision rules collaboratively generated prior to the start of the study. Any investigation undertaken adheres to all ethical considerations and associated oversight.

Quality of Life: MCCD non-academic goals and objectives focus on targets from a global perspective that includes:

• Regarding a specific skill (behavior) being taught, how will this benefit the person now and in the future?
• Is the person happy?
• Is the person productive?
• Is the person acquiring new friends?
• Is the person developing new skills?
• Is the person able to function independently in the community? (Risley, 1996)

Meeting the Family Where They Are: Merrymeeting Center’s Director of Psychological Services, Dr. Harold Longenecker, conducted his doctoral dissertation on parent stress related to having a child with autism. Dr. Longenecker’s research reveals that parents of children with autism endure extremely high stress levels as measured by several standardized instruments (Longenecker, 2002). While the research is clear that parent involvement in educational programming for children with autism helps improve outcomes, this needs to be weighed against when and how parents are involved so as not to be yet another stressor in the family’s life. Parent training is therefore encouraged, but optional.

Emphasis on Training, Supervision and Procedural Integrity: Currently, 20% of MCCD direct care professionals are Board Certified at some level. Our licensed Senior Psychologist is in the process of earning BCBA. Our licensed speech-language pathologist is currently a BCABA, finishing work toward the BCBA. The subcontracted occupational therapist is also pursuing BCBA.

All staff at MCCD are also required to attain the in-house certification of Behavior Analyst Technician 2 (BAT-2) within one year of employment. The services of a full time ABA trainer supports this, as well as on-going training needs specific to each child’s programming and learning style. In addition, every employee at MCCD has a Supervisor who supports staff well-being, professional development, and routine administrative needs. Supervisors meet with supervisees a minimum of two times per month face-to face, and numerous other 1:1, group and impromptu sessions as are needed to support the staff in this challenging work.

Supervisors are groomed and promoted from within, which helps to provide additional growth opportunities to direct care professionals. It is MCCD’s goal to minimize burnout by offering a balance of supervisory and direct care responsibilities. This helps us to ensure our most talented staff continue to work with our students.

MCCD professionals also have the support of a SOC, or “Supervisor on Call.” The SOC is on-site, and can immediately be summoned on business-band radios that all staff carry. SOCs assist with behavior managementprotocols, “teachable moments,” reliability checks, procurement of materials, and other collegial support. By invitation, high-performing staff may voluntarily participate in MCCD-run Business Leadership Training on their own time. This training is based upon business management theory as practiced by exceptional corporations, and is calculated to ensure staff perceive career paths sufficiently attractive to remain in the field of autism services.

Emphasis on Data Analysis and Rate of Learning: It’s been our experience that many organizations offering ABA services are strong in taking data, but less so when it comes to analyzing the data and fine-tuning interventions to increase rate of learning. For families struggling with a child’s skill deficits and challenging behaviors, rate of learning is of critical importance. Pre-requisite skills need to be mastered before skills of more direct social significance can be integrated into the child’s self sufficiency and the family’s quality of life. Therefore, MCCD’s academic, clinical, speech-language, training and administrative leaders meet weekly to review every program for every child. Data presented in these case reviews have been pre-analyzed by each sub-specialty, so attention is focused on those goals and objectives with which the child is having the most difficulty. Each weekly case review results in a list of Action Items, with the expectation that action will be taken before the next weekly meeting.

Supported Inclusion and Transition Services: In a sometimes contentious and litigious environment, one thing everyone who cares about a child with autism can agree upon is that the outcome objective for students is inclusion, in the least restrictive (effective) environment. MCCD works with families and schools to develop a transition plan from the Center to the school, most often based upon a gradual shaping process. Unlike most educational technicians, MCCD behavior analyst technicians (BATs) are intensively trained and supervised in the use of positive behavior support plans, behavioral interventions, and behavior analytic educational methods. Schools therefore frequently subcontract with MCCD to have our BATs in the school system for a period of transition, until the child with autism is sufficiently behaviorally stable, and learning in the mainstream environment with minimal special support. Merrymeeting Center is uniquely positioned, along with a handful of other science-based providers of autism services, to offer a high level of skill and sensitivity to family needs. As a small and still relatively new agency, MCCD recognizes and is committed to our responsibility to continue to learn, to train, and to apply best practices as they emerge.

Merrymeeting Center seeks to create openings for children diagnosed with autism and related developmental disabilities with minimum wait time by investing in ongoing recruitment, training, facility expansion and innovative partnerships with public and private schools. To find out more, refer a student, or investigate career opportunities, please contact:

Lora Perry MS, BCBA
Merrymeeting Center
2 Davenport Circle
Bath, ME 04530
(207) 443-6200 x203
(E-mail contacts preferred)

Reference

Parent stress related to having a child with autism: Impact of educational programming by Longenecker, Harold Quentin, Ph.D., Fielding Graduate Institute, 2002, 143 pages; AAT 3077548.