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Wandering a Risk for Individuals with Autism

May 29th, 2013

Individuals with autism spectrum disorders may be prone to wandering or elopement, which can raise a significant health and safety risk. It is important for family members and caregivers to be aware of the risks and prevention strategies.

Wandering may include moving about with no apparent fixed plan in mind, or moving toward a location such as a landmark or place of obsession. Individuals with autism may also respond to loud noises or excitement by wandering or quickly fleeing. Elopement refers to a situation where a person with autism leaves a safe setting unnoticed or unsupervised. One of the leading causes of death among people with autism is drowning, exposure and other wandering-related factors.

Wandering has a medical diagnosis code approved by the Centers for Disease Control. Caregivers for people at risk of wandering should discuss the diagnosis code with the treating physician. A medical diagnosis can be helpful in obtaining insurance coverage for safety equipment and support requests for safety equipment in a school environment.

Caregivers should also be aware of strategies to prevent and deal with wandering. The first step is to understand wandering patterns and triggers in order to be aware of the problem. The individual’s home should be as secure as possible and the individual should be made aware of the importance of safety. Caregivers should consider identification materials such as a medical ID bracelet and location devices such as a personal GPS locator. Swimming lessons should also be considered. Finally, caregivers should make sure that neighbors and first responders are aware that an individual with autism lives nearby, which may improve response if an incident occurs.

For more information about autism safety, visit www.autismsafety.org. To learn more about our legal services for people with special needs, visit www.specialneedsnewyork.com.

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Things To Look For In A Nanny For Special Needs Children

May 20th, 2013

Our guest blogger this week is Ken Myers, President of Morningside Nannies.

Having a child with special needs, you want to make sure he or she gets the care they require while you’re away. Not every nanny is equipped mentally and physically to deal with the kinds of stresses and requirements that are demanded of your child. You need to be able to trust that your nanny can handle any situation that may arise. When looking for a person that can fit that criterion, keep a few things in mind:

1. Experience – An ideal nanny would be one who has had experience dealing with children whose needs are similar to your own. Those who have experience in particular afflictions such as various stages of autism or ADHD can prove to be excellent nannies. While experience is definitely a bonus, it shouldn’t completely account for your decision on whether or not you should hire them to be your childcare provider.

2. Adaptability – Asking the right questions surrounding your specific needs can provide some insight to whether or not the candidate is going to be a good fit. Questions such as those that cover real-life daily routines and circumstances could provide you with a great deal of information on how well the nanny will perform. You should devise the questions to cover situations yourself has had to deal with in order to gauge the candidate’s answers against how you handled them. They might have a better solution than one you implemented.

3. Education – Special needs children require the caregiver to have a certain level of knowledge dependent on the type of care that is needed. You wouldn’t want to have a high school student with no knowledge of autism to care for your autistic child. Even if the person is pleasant with a spectacular nature to them, you still want someone who has knowledge of what to expect from your special need. A potential nanny that can produce that kind of knowledge and educational records is an ideal candidate. You shouldn’t have to train your nanny in order to care for your child.

4. Medical Training – Although you probably don’t need an actual doctor, medical training of any kind is always a great bonus. Nannies that are perfecting their skills caring for special needs children usually have more than basic CPR abilities. However, you shouldn’t allow the lack of medical training to dissuade you from a candidate who shows great potential in other areas.

5. Background Checks – It is always a good idea to perform a background check anytime you are inviting anyone to work, and possibly live, within your home. While they may have a shining resume, perfect application, and extensive knowledge of your needs, they could also be hiding the fact they are dodging an arrest warrant. Besides, the background check can reinforce the potential nanny’s information about experience and education, which can put your mind at ease that you hired the right person for the job.

Your nanny needs to be able to provide a safe and stable environment for your child. Depending on the needs of your child, this can become quite an involved task and you need to trust your caregiver to provide that environment. The last thing you need to have looming over your head is doubt that your nanny can be up to the task of caring for your child.

Ken Myers holds a master’s in business leadership from Upper Iowa University and multiple bachelor degrees from Grand View College.  As president of  morningsidenannies.com, Ken’s focus is helping Houston-based parents find the right childcare provider for their family. When he isn’t working, he enjoys spending time with his three children and his wife.

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Navigating the Process of Applying for Social Security Disability Benefits

May 14th, 2013

Disabled individuals who cannot work are entitled to Social Security disability benefits, but the process of applying can be lengthy and difficult. The majority of applicants are denied benefits at the outset, and they may be uncertain of how to proceed.

When we discuss Social Security disability benefits, we are talking about two different programs. Social Security Disability Insurance (SSDI) is available to people who have paid into the Social Security system through taxes during the 10 years before they became disabled. Supplemental Security Income (SSI) is available for people who have not paid enough into the system to be eligible for SSDI. To be eligible for either type of benefits, one must be “unable to engage in any substantial gainful activity” – i.e. “work” – because of a “medically determinable” disability lasting one year or more or expected to result in death. The questions of whether or not an individual is disabled and whether or not he or she can work are the key factors in determining eligibility for benefits.

The first stage in the process is the initial interview. A disabled individual may contact the Social Security Administration (SSA) to set up an appointment. One must have been disabled for five months before applying for SSDI benefits; there is no waiting period for SSI benefits. An applicant should bring two forms of identification to the interview, and any medical records that provide evidence for the disability. If there are records the person has not obtained, he or she may sign a medical records release form permitting the SSA to obtain them. If an individual is not able to go to a Social Security office, he or she may conduct the interview by telephone or appoint another person such as a family member to represent the disabled person at the interview. The process of deciding on the application takes from three to six months.

The majority of claims are denied at the initial application stage, but this should not deter disabled individuals from continuing with the process. Often a denial is the result of insufficient records or information that has not been presented persuasively. The second stage of the process is a request for reconsideration, which also involves an interview and the submission of any additional evidence. If the request is denied, then the third stage is to file for a hearing before an administrative law judge. An attorney can assist an applicant at any stage of the process; at the hearing stage and beyond, such assistance may be invaluable.

At an administrative hearing, the disabled person may present the testimony of witnesses and any other additional evidence. The government may also hear the testimony of a vocational expert and/or a medical expert who will offer their expert opinions regarding whether the applicant is disabled and whether he or she is unable to work. If the applicant is unsuccessful at this stage, he or she may file a claim with the Appeals Counsel Review Board. If the appeal is denied, then the last option is a civil lawsuit in District Court.

At any stage at which the benefits are granted, they will be retroactive to the date of the original application. If it is determined that the disabled individual is not able to handle the cash benefit appropriately, then a representative payee will be appointed to handle the money for the disabled person’s benefit.

For more information about disability law, visit www.specialneedsnewyork.com.

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Study Finds Respite Care Important for Parents of Children with Autism

May 14th, 2013

Parents of children with autism spectrum disorders often experience high levels of stress and marital problems when compared with other parents. Much of this stress is the result of the greater amount of caregiving needed when raising a child with autism. A recent study shows that being able to take a break from caregiving, even just for an hour per week, decreases stress and improves the quality of a marriage.

The study was published in the Journal of Autism and Developmental Disorders. Researchers surveyed the parents of 118 children with autism spectrum disorders and found that the number of hours of respite care per week was directly related to better marital quality. There was also an association between respite care and a reduction in stress.

About 64 percent of the children in the study spent time with a respite care provider, such as grandparents, other family members, babysitters and community agencies. The study found that for every hour per week of respite care, there was less stress and better marital quality. The researchers said that it is important for supports for respite care to be developed for families raising children with autism.

The study adds to what is already known about the importance of respite care for parents of kids with autism. A study last year found that children with autism had a reduced risk of psychiatric hospitalization when their parents were able to take advantage of respite care.

For more information about our legal services, visit www.specialneedsnewyork.com.

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Today is National Children’s Mental Health Awareness Day

May 9th, 2013

By Marion Walsh, Esq.

Today is National Children’s Mental Health Awareness Day.   Statistics show evidence of increasing mental health issues in children.   Chances are everyone knows a child struggling with mental health issues. According to statistics from the Surgeon General, approximately one in five children in the U.S. will experience a mental, emotional, or behavioral disorder between kindergarten and graduation. Failure to address children’s mental health needs is linked to poor academic performance, behavior problems, and school violence, dropping out, substance abuse, special education referral, suicide, and criminal activity.

Despite the high frequency and children’s clear needs for help, too many myths and unspoken stigmas plague families who have children struggling with mental health issues.  Clearly, a public health approach is necessary to address disorders and promote mental health in children.    Parents and school districts must forge partnerships to address this unfolding crisis.  Indeed, along with help from medical providers, they are the only ones who can.  However, funding cuts and tax caps in school districts have made the problems harder to address.

Signs of Mental Health Problems in Children:

The Mayo Clinic and other professionals list the following signs of mental illness in children:

· Mood changes: Look for feelings of sadness or withdrawal that last at least two weeks or severe mood swings that cause problems in relationships at home or school.  Some students simply withdraw.  School avoidance or physical symptoms without physical causes can also be a sign of mental distress.

· Intense feelings: Be aware of feelings of overwhelming fear for no reason — sometimes with a racing heart or fast breathing — or worries or fears intense enough to interfere with daily activities.

· Behavior changes: Look for drastic changes in behavior or personality, as well as dangerous or out-of-control behavior. Fighting frequently or expressing a desire to hurt others also are warning signs.

· Difficulty concentrating: Look for signs of trouble focusing or sitting still, both of which might lead to poor performance in school.

· Unexplained weight loss: A sudden loss of appetite, frequent vomiting or use of laxatives might indicate an eating disorder.

· Physical harm: Sometimes a mental health condition leads to suicidal thoughts or actual attempts at self-harm or suicide.

· Substance abuse: Some children use drugs or alcohol to try to cope with their feelings.

Why the Prevalence of Mental Health Problems in Children?

On the one hand, our world and schools are much safer and enlightened than decades ago.  Most states have outlawed corporal punishment; laws require services and accommodations for children with disabilities; parents monitor teachers’ abuse and vice versa; therapists are around every corner.    Clearly we are diagnosing disorders more precisely.   However, our society is more stressed, anxious and pressured.   Many parents must work long hours and do not see problems until they become crises.  The Internet has unleashed cruelty and crudeness of a previously unimagined scope.   Single parent families add risk factors.  In general, children may receive little training in ethics at home nor at school.  The accessibility of assault rifles shocks the conscience and makes apocalyptic violence a potential threat.

Legal Basics:

Parental Responsibilities:

Obviously, parents have a legal duty to care for their children and family represents the first source of support for a child’s mental health.  However, the increased stress and fracturing of life today makes it imperative that schools partner with parents to help children.   Parents must take a proactive role in helping their school district understand their child’s needs and also finding private help.   Yet parents, while closest to their children, can be in denial of serious problems.  A social partnership is necessary.

School District Responsibilities:

As noted by the National Association of School Psychologists, schools represent excellent places to promote good mental health.   Children spend a significant amount of time in school, and educators have the opportunity to observe and address their needs. Doing so effectively requires developing the capacity both to reinforce children’s natural mental health strengths and to identify and respond to children suffering mental health disorders.

Not every child with mental health issues has a disability but if a condition affects educational performance, the student should be referred for special education and related services.    Pursuant to the Individuals with Disabilities Education Improvement Act (IDEA), 20 USC §1400, et. seq. and parallel state law, school districts have a responsibility to identify and provide appropriate services to students with disabilities, including those who have an emotional disturbance or disability. As the Supreme Court noted in Honig v. Doe in 1988, “Among the most poorly served of disabled students were emotionally disturbed children: Congressional statistics revealed that for the school year immediately preceding passage of the Act, the educational needs of 82 percent of all children with emotional disabilities went unmet. See S. Rep. No. 94-168, p. 8 (1975).”

Under the 2006 IDEA Part B regulations, 34 CFR §300.8 (c)(4)(i), “emotional disturbance ” means a condition exhibiting one or more of the following characteristics “over a long period of time and to a marked degree that adversely affects a child’s educational performance”:

(A) An inability to learn that cannot be explained by intellectual, sensory, or health factors.

(B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers.

(C) Inappropriate types of behavior or feelings under normal circumstances.

(D) A general pervasive mood of unhappiness or depression.

(E) A tendency to develop physical symptoms or fears associated with personal or school problems.

Steps School Districts Can Take:

School districts should develop a task force and work with community members to create systems and policies to proactively address student mental health needs.

1. Develop Effective Child Find and Special Education Programs with Effective Evaluations

2. Provide Effective Monitoring and Building Level Interventions

3. Train to Spot Signs of Mental Illness in Children and to Take Affirmative Steps

4. Develop Effective Anti-Bullying Programs (Bullying exemplifies and causes mental health problems).

5. Provide Parent Education and Parent Counseling and Training

6. Cultivate Partnerships with Outside Agencies

What Does Not Work

The Blame Game:

Schools often expect parents to have private mental health services to address school behavior.  Parents without resources cannot pay for private services and the community based resources have very long waiting lists.  Parents who can afford the services may not be able to address the behavior that is based in school or caused by the school environment. Often the parents get blamed for not “dealing” with the problem.  Parents also blame the school personnel for not addressing the problem.  The blame game can go in circles.  It only causes more stress to families and drains resources from schools which are facing shrinking budgets.

Review of Federal Litigation:

In the Second Circuit, which has more education law litigation than any other jurisdiction, litigation over children with emotional disturbances exceeds litigation over other types of disabilities.   Most litigation centers around whether schools provide a free appropriate public education to children under the IDEA, which is the most powerful statute available to students and families in ensuring appropriate services from school districts.   Much of IDEA litigation in the Second Circuit centers around tuition reimbursement after parents unilaterally remove their child from public school.

No matter which side is ultimately successful, case law only demonstrates failed attempts at addressing mental health issues. For example, in Gagliardo v. Arlington Central School District, 489 F.3d 105 (2d Cir. 2007).   In this case, the student exhibited symptoms of anxiety, depression and social phobia, beginning in fifth grade and lasting for the next seven years throughout high school.  The parents finally removed the student from public school and initiated litigation to seek reimbursement for tuition at a supportive private school. The Southern District found that the District denied the student a free appropriate public education and awarded tuition reimbursement. But, the Second Circuit overturned the reimbursement award and ruled that the private school did not provide individually tailored services for the student’s unique needs.   This decision came five years after the litigation began. See also Eschenasy v. New York City Department of Education, 604 F. Supp. 2d 639 (S.D.N.Y. 20008). (Court found that student who cut class, took drugs, stole and engaged in hair pulling, cut herself, had attempted suicide and was diagnosed with a mood disorder and borderline personality features had an emotional disturbance under the IDEA and that the school district had denied her a FAPE and had to pay the parents tuition reimbursement as private school was appropriate).

Conclusion

Every parent and school professional must be aware of the impending mental health crisis confronting our youth and take steps to understand and advocate.  Parents and schools must act together to protect children become educated on risk factors and symptoms of mental health issues.

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