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Physical Activity

A Nurse Practitioners Note on Physical Activity

Michael Ann Vaughn is a graduate of the University of Washington’s Doctor of Nursing Practice program, specializing in Pediatric Primary Care. She completed the LEND Fellowship (Leadership Education in Neurodevelopmental and Related Disabilities) through UW to focus on her passion for working with children who have ASD and neurodevelopmental disorders. She earned her BSN from Montana State University in Missoula, MT. Her nursing experience includes working at Valley Medical Center’s Neonatal Intensive Care Unit.

She is excited about the opportunity primary care offers to improve the health and lives of children and their families by providing support, resources and medical attention.

Benefits of physically active:

• Strengthen bones and muscles

• Maintain appropriate weight

• Improve sleep 

• Improve school performance

• Decrease risk of diabetes, high blood pressure, high cholesterol, anxiety, depression 

• Important for growth and development

 

Tips for Physical Activity

• Kids 6-17 years old should have at least 60 minutes of physical activity each day at a moderate to vigorous level 

• Moderate physical activity: breathing faster than normal, starting to sweat after 10 minutes of the activity. Example: brisk walk 

• Vigorous physical activity: breathing deep and rapid, sweating after a few minutes of the activity. Example: running 

Make it fun! Show kids being active is part of every day and that it’s something to enjoy. This will help them continue healthy habits as they get older 

Mix things up! Throw in different ways to be active, and use it as an opportunity to spend time together as a family 

 

WEEKLY FAMILY CHALLENGE! Create an obstacle course! Indoor or outdoor. Get creative with the obstacles (keep safety in mind). 

  • Jump over a towel
  • Walk on a line made of tape
  • Run around cones or cups
  • Jump to touch object taped to ceiling
  • Crawl under a table
  • Throw a ball to hit a target
  • Tip-toe through scattered socks
  • Make a section “walk like a crab,” or “hop like a frog”
  • Add hopscotch to the course
  • “Happy dance” station
  •  Victory shout at the finish line

 References:1. Mayo Clinic. Exercise Intensity: How to Measure it. https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887. Updated June 12, 2018. Accessed January 9, 2019. 2. HealthyKids. Motivating Kids to Be Active. https://kidshealth.org/en/parents/active-kids.html. Updated June 2018. Accessed January 9, 2019. 3. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. Washington, DC: U.S. Department of Health and Hu-man Services; 2018. 

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Fever

A Nurse Practitioners Note on Fever

Michael Ann Vaughn is a graduate of the University of Washington’s Doctor of Nursing Practice program, specializing in Pediatric Primary Care. She completed the LEND Fellowship (Leadership Education in Neurodevelopmental and Related Disabilities) through UW to focus on her passion for working with children who have ASD and neurodevelopmental disorders. She earned her BSN from Montana State University in Missoula, MT. Her nursing experience includes working at Valley Medical Center’s Neonatal Intensive Care Unit.

She is excited about the opportunity primary care offers to improve the health and lives of children and their families by providing support, resources and medical attention.

 What is a fever? 

• Medically defined as over 100.4º F or 38º C

• Usually harmless

• A sign the child’s immune system is working and fighting off an illness 

• Can be caused by many different things. Some common causes of fever in kids: viral illness (like the common cold), flu, ear infection, urinary tract infection 

• Can be environmental

 

 What can I do for my child if they have a fever? 

  • Let them rest
  • Provide them comfort and activities that help them feel better: bath or shower, cool washcloth on head
  • Encourage fluids: water, juice, or Pedialyte
  • Can give acetaminophen (Tylenol) or ibuprofen to help them feel better. Make sure it’s the correct dose for your child’s age and weight. Ibuprofen is NOT used for infants under 6 months. 
  • DO NOT give aspirin to children 

 

 When fever indicates to contact a medical provider: 

  • Child looks very sick 
  • You’re concerned about dehydration
  • Your child has a chronic medical condition 
  • Child has one or more of the following symptoms with their fever: Stiff neck, rash, bad headache, sore throat, ear pain, lethargic, bad stomachache, repeated vomiting or diarrhea, decreased response to your voice 
  • Fever that lasts for more than 24 hours if child is less than 24 months old
  • If you are concerned about your child’s symptoms or behavior 
  • Child was left in a hot environment like a car 
  • Infant 3 months or younger with a fever
  • Fever lasting longer than 3 days
  • Fever over 103ºF or 39.4º C

 Questions? I would love to hear from you! 

 Fever is a big topic and this is just a brief overview. ICAN Pediatrics would love to hear from you! 

 References:

 References: 1. American Academy of Pediatrics. Plain Language Pediatrics: Fever. https://patiented.solutions.aap.org/handout-collection.aspx?categoryid=32035. Updated 2008. Accessed November 5, 2018. 2. American Academy of Pediatrics. Point-of-Care Solutions. Fever and Your Child. https://patiented.solutions.aap.org/handouts.aspx. Updated 2018. Accessed November 5, 2018. 3. Mayo Clinic. Fever. https://www.mayoclinic.org/diseases-conditions/fever/symptoms-causes/syc-20352759. Updated July 21, 2017. Accessed November 6, 2018. 

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The Flu

A Nurse Practitioners Note on The Flu

Michael Ann Vaughn is a graduate of the University of Washington’s Doctor of Nursing Practice program, specializing in Pediatric Primary Care. She completed the LEND Fellowship (Leadership Education in Neurodevelopmental and Related Disabilities) through UW to focus on her passion for working with children who have ASD and neurodevelopmental disorders. She earned her BSN from Montana State University in Missoula, MT. Her nursing experience includes working at Valley Medical Center’s Neonatal Intensive Care Unit.

She is excited about the opportunity primary care offers to improve the health and lives of children and their families by providing support, resources and medical attention.

 What is the flu? 

• Influenza is a viral illness that impacts the entire body. 

• Can last over a week. Usually people fully recover, but it can be fatal. 

• The illness has a quick onset of fever, cough, headache, body aches, fatigue, stuffy nose, sore throat, vomiting, or diarrhea. 

• It is spread by droplets in the air or by touching a contaminated surface and then touching your face. 

 

PROTECT your family from the flu: 

  • Get the flu vaccine. Younger children are at higher risk for complications from the flu. 
  • Teach kids to cover their cough.
  • Frequent and through hand washing.

 

 Why get the flu vaccine? 

  • The flu vaccine decreases your chance of getting the flu. 
  • If you still get the flu after vaccination, symptoms may be less severe. 
  • If you’re vaccinated, you help protect others! 
  • Being vaccinated decreases rate of hospitalization and death from flu. 

 Important Things To Remember: 

  • NEVER GIVE A CHILD ASPIRIN 
  • DO NOT GIVE COUGH OR COLD MEDICINE TO CHILDREN UNDER 4 YEARS OLD 
  • ANY CHILD UNDER 3 MONTHS OLD WHO HAS A FEVER NEEDS TO SEE A PROVIDER IMMEDIATELY 
  • BEFORE GIVING TYLENOL OR IBUPROFEN, CONFIRM IT IS THE RIGHT DOSE FOR YOUR CHILD’S AGE AND WEIGHT

 Questions? I would love to hear from you! 

We are entering flu season. If your child hasn’t been vaccinated yet, you can stop by and get their flu shot here at ICAN Pediatrics! 

 References:

1. American Academy of Pediatrics. The Flu. https://patiented.solutions.aap.org/handout.aspx?resultClick=1&gbosid=166301. Updated 2008. Ac-cessed October 29, 2018. 2. American Academy of Pediatrics. Cough and Cold Medicine—Not for Children. https://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Cough-and-Cold-Medicine-Not-for-Children.aspx. Updated 2018. Accessed October 29, 2018. 3. CDC. Protecting Against Influenza (Flu): Advice for Caregivers of Young Children. https://www.cdc.gov/flu/protect/infantcare.htm. Updated September 7, 2018. Accessed Octo-ber 30, 2018. 4. HealthyChildren.org. The Flu. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/The-Flu.aspx. Updated September 7, 2017. Accessed October 29, 2018. 

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Bullying

A Nurse Practitioners Note on Bullying

Michael Ann Vaughn is a graduate of the University of Washington’s Doctor of Nursing Practice program, specializing in Pediatric Primary Care. She completed the LEND Fellowship (Leadership Education in Neurodevelopmental and Related Disabilities) through UW to focus on her passion for working with children who have ASD and neurodevelopmental disorders. She earned her BSN from Montana State University in Missoula, MT. Her nursing experience includes working at Valley Medical Center’s Neonatal Intensive Care Unit.

She is excited about the opportunity primary care offers to improve the health and lives of children and their families by providing support, resources and medical attention.

Talking with your child about bullying can help them be prepared and know how to respond in a situation. Bullying can occur in the following forms:

  • Physical
  • Verbal
  • Social
  • or Electronic

Being bullied increases risks of:

  • Anxiety
  • Depression
  • Suicide
  • Substance Abuse
  • Violence
  • Academic Performance

How can parents help prevent or stop bullying?

  • Talk to your child about bullying before it becomes and issue. Help them think through how they will respond in different situations. 
  • Tell children if they experience or witness bullying, always report it to an adult. Children who are bullied may feel embarrassed and may not want to admit they’re being bullied. 
  • Model respectful and kind behavior as much as possible. 
  • Anytime you witness bullying, respond in a quick and consistent manner to demonstrate bullying is not ok. 

How a child should respond to bullying:

  • Keep calm, try not to show emotion, walk away, tell an adult. 
  • If the child must respond  to the child bullying them: stay calm, stand tall, try not to show emotion, and use a strong voice for a clear statement, “I don’t like what you are doing.”

My child told me they are being bullied, now what?

  •  Listen to your child, help them feel heard, assure them it is not their fault.

  • Work together with your child, teachers, and school administrators to develop a plan that can help the child feel safe.

  • Find a mediator between parents, usually a school employee. 

  • Work to build up your child’s self-esteem by encouraging your child to praise themselves for things they can be proud of. 

  • Consider seeing a healthcare provider or mental health counselor to determine if additional action is needed 

 

Questions? Children who bully others, children who are bullied, and children who witness bullying are all impacted and in need of some guidance on how to develop appropriate skills that will benefit them throughout life. Being informed gives you better tools to help your child. 

 

References: 

1. StopBullying.gov. Bullying. https://www.stopbullying.gov/what-is-bullying/index.html Updated July 26, 2018. Accessed October 22, 2018. 

2. HealthyChildren.org. Bullying: It’s Not Okay. https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Bullying-Its-Not-Ok.aspx. Updated November 21, 2015. Accessed October 22, 2018. 

3. HealthyKids. Dealing with Bullies. https://kidshealth.org/en/kids/bullies.html. Updated July 2013. Accessed October 22, 2018. 

4. Mayo Clinic. Bullying: Help Your Child Handle a Bully. https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/bullying/art-20044918. Updated August 26, 2016. Accessed October 22, 2018. 

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Company News Autism Spectrum Disorders - News and Research

Improving Your Child’s Sleep

A Nurse Practitioners Note on Sleep

Michael Ann Vaughn is a graduate of the University of Washington’s Doctor of Nursing Practice program, specializing in Pediatric Primary Care. She completed the LEND Fellowship (Leadership Education in Neurodevelopmental and Related Disabilities) through UW to focus on her passion for working with children who have ASD and neurodevelopmental disorders. She earned her BSN from Montana State University in Missoula, MT. Her nursing experience includes working at Valley Medical Center’s Neonatal Intensive Care Unit.

She is excited about the opportunity primary care offers to improve the health and lives of children and their families by providing support, resources and medical attention.

Adequate sleep is a necessity for the physical and mental growth and development that is taking place throughout infancy, childhood, and adolescence. Unfortunately, it is not always easy for a child to get the recommended amount of sleep.

The proper amount of sleep can positively impact:

  • Behavior
  • Attention Span
  • Emotional Regulation
  • Mental and Physical Health
  • Developing habits that will benefit the child throughout their life

Too little sleep can negative impact the areas listed above.

Tips to Improve Sleep:

  • Routine, Routine, Routine
  • Having the same schedule of events leading up to bed time and a consistent bedtime are extremely helpful
  • In the morning, praise the child for going to bed well the night before
  • Give a child a 30 minute warning when bedtime is approaching
  • Sunshine and physical activity during the day

Bedtime Routine Ideas:

  • Visual schedule of the routine
  •  Calming activities like a bath
  • No TV or screen light at least 1 hour before bedtime
  • Read to your child before bed (this also improves their language development!)
  • Sing to your child
  • Soothing sounds, white noise

Questions? Every child is unique in sleep requirements and sleep struggles. If you are concerned or would like to discuss other ideas to improve your child’s sleep, I would love to spend time discussing how we can best help your child.

Sleep Resources: HealthyChild.org, Autism SpeaksWebsite, Healthline.com,ZeroToThree.org

References:

  1. American Academy of Sleep Medicine. Recharge with Sleep: Pediatric Sleep Recommendations Promoting Optical Health. https://aasm.org/recharge-with-sleep-pediatric-sleep-recommendations-promoting-optimal-health/.Updated June 13, 2016. Accessed October 15, 2018.
  2. Healthychildren.org. Toddler Bedtime Troubles. https://www.healthychildren.org/English/healthy-living/sleep/Pages/Bedtime-Trouble.aspxUpdated December 6, 2011. Accessed October 15,2018.
  3. Weiss SK, Malow BA. Strategies to Improve Sleep in Children with Autism Spectrum Disorders: A Parent’s Guide. Autism Speaks and Autism Intervention Research Network on Physical Health.https://www.autismspeaks.org/sites/default/files/2018-08/Sleep%20Tool%20Kit.pdf
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Company News General

ICAN Partners with Innov8

 

 

ICAN Partners with INNOV8

 

Dear parents and families of ICAN,

 

We are pleased to announce a partnership with the company Innov8, a technology company focused on creating software applications focused on improving access to services for families affected by autism and neurodevelopmental disorders (www.innov8.care).

 

Our initial priority with Innov8 and application development involves the early identification of neurodevelopmental disorders. We have taken a considerable amount of time and effort collaborating with expert psychologists, software developers and technology leaders to create an easy to use application and process to screen for the red flags in a child’s development.

 

We are thrilled to present an opportunity to our families to be the first to try our application and provide much needed feedback to help us create the best possible outcomes and experience.

 

If you are interested in this opportunity, there are a few things we need:

 

  • You must have a valid Apple ID.
  • Send us an e-mail to info@innov8.care with a valid Apple ID. We will then send you a link to download a trial application called “test flight.” Through test flight, you will be able to download and use our application “iscreen.”
  • Provide feedback in person or online.

***At this time, we are only offering this application through apple devices. ***

 

We appreciate your contributions and support for the ongoing advancement of identification and diagnosis and care for children and families affected by autism and neurodevelopmental disorders. If you have any questions, you can reach us at info@innov8.care.

 

Thank you

 

ICAN and Innov8

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Company News General Insurance

BEACON

We believe now is a time when we must take a stand about doing the right thing and not give into the pressure from an insurance company. For this reason, we recently decided to cancel our contract with Beacon.

Providers are constantly facing downward pressure from insurance companies, including but not limited to poor/reducing reimbursement, slow reimbursement, lack of transparency, incompetent staff, and conflicting information. At ICAN we do understand that this is a challenge in the world of providing health care. However, there comes a time when requirements of insurance companies prevent providers from doing what is in the best interest of the patient. At that time, one must make the difficult decision to terminate their contract with the insurance company.

At ICAN we provide care to very complex patients and provide a range of services to support those patients. One of the services we provide is called applied behavior analysis or ABA. ABA has been shown to be the most evidence based service of improving the lives of children with autism and other neurodevelopmental disorders. This specific service has a structure and process that has been determined to be best practices. Because it is a relatively new field and one that, until recently, was not covered by insurance (many insurers now cover it because they were sued); standardized codes for billing the services have not existed. The codes that exist today are referred to as “t” codes or trial codes. These codes are intended to describe a service that you are providing that the insurance company can review and then make payment. As a part of best practices in ABA, the tiered structure includes both direct (face-to-face with patient) and indirect (patient is not present) case supervision activities such as treatment planning (to learn more about this structure and best practices please refer to the letter and attached information below. At this time, there are only “t” codes for direct case supervision activities. There is no “t” code, currently, that allows for the required ABA component of indirect case supervision.

We believe in integrity and ethical behavior and what Beacon asked us to do violates this value. In our discussions with Beacon, we were asked to bill for the indirect service treatment planning, among other indirect services using codes defined as direct services. The codes Beacon suggested we use do not have a description of treatment planning or indirect case management services. When we asked Beacon to put this direction this in writing, they declined to do so.

We know that not participating in Beacon contracts will be disruptive for some patients and clinicians. Our goal as multi-disciplinary and integrated provider is to always make the best decisions so we can continue providing quality health care services and the terms that Beacon presents to us does not align with best practices and our ability to accomplish this goal.

We are disappointed we were unable to come to terms with Beacon, but this does not mean it isn’t possible for ICAN to develop a new contract with Beacon in the future.

“To Whom It May Concern,

Being that health plan coverage for Applied Behavior Analysis (ABA) treatment for individuals with Autism Spectrum Disorder(ASD) is relatively recent, this letter and its addenda are provided as a tool to navigate essential components of an ABA program.

Like other medical practices and treatments, ABA and its essential components are based on technologies documented in peer-reviewed literature and established treatment protocols. The Behavior Analyst Certification Board (BACB) has published numerous sets of guidelines for ABA practitioners to follow. A common element throughout the literature and thus the BACB guidelines is the vital role of the Board-Certified Behavior Analyst (BCBA). Their training includes a graduate degree with specified coursework in behavior analysis, extensive supervised fieldwork, culminating in a comprehensive board exam. In short, the BCBA creates and oversees the implementation of each treatment plan. Their ongoing direct assessment, data analysis and treatment plan modifications are foundational to each ABA program for an individual with ASD.

To provide a clear but comprehensive description of the role of a BCBA within the treatment model of ABA, the attached addenda are excerpts from their article entitled Health Plan Coverage of Applied Behavior Analysis Treatment for Autism Spectrum Disorder. This and other articles on ABA can be found in their entirety on the BACB website: www.bacb.com. Section 2, Part 2of the article discusses the essential components of an ABA program. Items 9 and 11 specifically discuss the necessary contributions of a BCBA. Section 5, Part 1 describes the tiered service delivery model and illustrates the role and responsibilities of a BCBA. Additionally, this section describes the activities associated with supervision and the need for both direct and indirect services.”






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Company News General Insurance

EviCore

We wanted to keep you informed of the challenges associated with some insurance plans. There are a number of plans that are moving to require pre-authorization of ALL of your treatment services. If your plan is one that requires pre-authorization your insurance will not cover your treatment unless it is separately approved by eviCore a medical utilization management company. We want you to be aware of the impact on your care with such a program and that you do have the power to change the system. Below you will read a general description of how this program is implemented, what the impact is and what you can do about it.

After your initial treatment and before we provide treatment, we are required to seek approval from eviCore through completion of forms, via their website or by phone. They require extensive information that must be provided in a format different than what you have seen in any of our documents. Due to website issues or call volumes this process may prevent you from being able to schedule appointments immediately after your first visit. If there is a delay, we will stay in touch with you to coordinate future appointments. After we submit the required information, eviCore will tell us how many initial visits are authorized and the duration over which those visits are authorized. Any time there is an authorization decision, you will receive a letter of their decision.

Depending upon your diagnosis, eviCore may authorize as few as 2 initial visits to be provided over the course of a period of perhaps 30 to 90 days. Even if our providers have determined that your child should receive more care more frequently. This initially authorized number of visits includes the evaluation visit. If your providers determine that your child needs additional care at the end of the initial number of visits and time period authorized by eviCore, our team will be required to submit a new request and provide more documentation, again in a format specified by eviCore. Additional requests for treatment authorization can require up 60 to 120 minutes of a therapist’s time, time for which the therapist and the clinic will not be compensated by your insurance.

Unfortunately, and despite our efforts, the process of requesting authorization for additional visits may result in an interruption or delay in your care. If, for example, eviCore initially authorizes only 2 visits over a period of 30 days and you use those visits in, say, one week, we may be able to request additional visits without waiting for the expiration of the 30 days and eviCore may grant those visits over a new specified time period. For any subsequent requests, we are required to wait until 7 days before expiration of the new time period before we can request additional care. This may mean that you will have to wait to receive some of your care in order to have that care covered by your insurance.

In the event that some or all of subsequent requests for authorization of your care are not approved by eviCore, meaning that additional visits will not be covered by your insurance, we will be happy to discuss the differences in the personalized care plan our therapist prepared for your child and what your insurance will cover. Although our contract with your insurance states we are to use our professional judgment to provide you with the care we see is medically necessary, we cannot guarantee that the pre-authorization, coverage or payment decisions will be the same as what we or your doctor see is medically necessary for your child. With your signed consent and agreement to be financially responsible for any specific services that your insurance does not cover, we can proceed to care for you with the goal of achieving the best outcome we can for your child and family.

We want to be very transparent with you regarding the impact on your child’s care with a program like this because it is being promoted as an improvement by your insurance plan. The following is a summary of the issues as well as what you can do.

1) eviCore is limiting the services and care that you are able to receive.

2) The authorizations that are granted by eviCore are not in line with what best practices are for speech, occupational, applied behavior analysis or other therapies for your child’s diagnosis. The authorizations also do not reflect the recommendations of our professionals and will harm your child’s outcome.

3) We have been in touch with both your insurance and eviCore regarding issues with this program but the only way they will change is through your efforts.

4) Many benefit plans can opt out of eviCore. Please contact your HR department about eviCore and the issues you experience

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Company News General

8 EPIC YEARS!!!

WOW! We are celebrating another year here at ICAN. The best part is celebrating with the tremendous hard working team here. They are truly dedicated, passionate and drive people that want to make a difference in so many ways. Thank you to our team and thank you to the families that have trust in us to provide the best hope and future!

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Thank you Speech Team!

<a href="https://i2 click this site.wp.com/lakesideautism.com/wp-content/uploads/speech-pic.png”>speech picIt is better speech and hearing awareness month! We would like to thank our amazing speech therapists for their commitment to the families of ICAN. They are a tremendous group of professionals committed to the best hope and future. Thank you John, Mary, Heather, Kalayla, Carrie and Cameron!