Season 3, Episode 5: Let's Talk About Autism Clinical and Educational Services with Special Guest Dr. John Molteni of Prism Autism Education & Consultation

Speaker 1: 0:03

Welcome to the podcast. Let's talk sped law, a podcast dedicated to discussing special education rights of children with disabilities. I'm your host and special education attorney. Jeff forte. Now let's talk sped law. I ruined

Speaker 2: 0:18

And welcome to another episode of let's talk sped law today on the podcast we have Dr. John[inaudible]. Um, I've been meaning to have Dr. [inaudible] on for quite some time. Um, and, uh, his schedule permitted us to do this recording today. So, uh, it's great that John's on the, uh, on the podcast. Dr. Hall is currently the director of behavioral health at prism autism education and consultation. He is a clinician and educator with over 20 years of experience in the field of autism and developmental disabilities as a psychologist behavior analyst, and as an educator, and he's provided clinical and educational services for children on the spectrum with and-or with developmental disabilities, for children, from as young as preschool, all the way through adulthood in various settings, he had the opportunity, um, previously in his career to establish a neat unique program within public schools and a clinical program at the hospital for special care, uh, where he launched the autism center, an outpatient clinic, and, um, it's one of 10 in the country. Now he is over at prism, autism education and consultation, and he is here today to share not only news about their clinic, but also about their new launch prism Academy. Uh, John, welcome to let's talk, sped law.

Speaker 3: 1:50

Thanks, Jeff. Great to be here.

Speaker 2: 1:52

So, you know what, let's talk first about how your, uh, how your role, um, has grown, um, on the senior management of, of prism and what you're doing over there right now. What are you currently doing?

Speaker 3: 2:08

Sure. Yeah. Well, I came over to prism in, uh, the end of 2019. So December, 2019, and that was to sort of open up a behavioral health clinic, um, where we could provide diagnostic services, um, school-based consultation, IAES, um, independent educational evaluations, you know, and provide some psychotherapy. These were some of the things I was doing at the hospital for special care. And we were going to start that over at prison mechanic, which we have done. Um, and we continued to provide those services, uh, shortly into my tenure at prism. Uh, and literally four months after I started the, uh, pandemic started. And, um, we started to have some requests from prior learners at the clinic. Our clinic is an intensive early intensive behavioral clinic. Um, we generally serve children from as young as one year to about six years of age. And so some of our learners had left to go to public school and they started to return, um, because their schools had closed and we were still open as a medical facility and we were still serving children. Um, of course we said, yes, these were families that we had served for several years and we were sort of eager to have them come back and enjoy our clinic. And when we did, so we kind of saw a lot of them came back with skills that were, um, we saw some regressions, parents were reporting some regressions. We were seeing some difficulties in terms of their skills that they had demonstrated with us and in their homes prior to their leaving, that were no longer being demonstrated. Uh, we had had a fairly, uh, robust strategic plan to start a school at some point, um, giving me some time to develop behavioral health and, and, and do some other things. Um, but this sort of accelerated our timeline and, and we said, well, what can we do now, uh, to really prevent this, um, from occurring again? Um, interestingly, when we, I'm sure you've had these conversations with other, uh, folks on your podcast is when a kid turns ages out of the special education status. And we often talk about that as a cliff, right? There's a cliff that they fall off and services are not necessarily where they should be at very young ages. There is also a cliff, um, when you receive 40 hours of intensive, uh, intervention, and then you attend a public school, not to say that public schools aren't intensive, but the level of intensity to address core symptoms of autism and while also addressing educational needs does tend to fall off. Um, so our goal was to say, how do we continue to provide those intensive services within an educational framework? And so we decided to start prism Academy at the end of August of last year. And, uh, you know, we're currently in our first year of operation.

Speaker 2: 5:09

That's great. You know, it's not often that a school is a new, special education school gets created. So, um, and gets created during, during a COVID pandemic. So I'm sure you have your work cut out for you on that front. Um, but let's get into it a little more, um, you know, before, before we get into prison, macademia in general, right? What are kind of the general clinical considerations that a parent should be thinking about with their public school district team when they're thinking about or seeking and requesting a, uh, more therapeutic, private outplacement, such as a school like prison Academy? Yeah. Yeah. And

Speaker 3: 5:58

It's certainly not for everyone. And one of the duties that I've held over the past a dozen or so years is doing evaluations for schools, districts, or for parents, and talk about what types of programming, uh, would benefit the student that I'm working with. And, um, you know, most of the time when we think about the needs of the student and what they might need, uh, uh, educationally, you know, it, it always comes down to an intensity. You know, it's a lot of it is about how often are we targeting those skills that we've identified in the IEP so that the individual can practice those skills. Um, what is the training like of the staff to support that across an entire school day in different environments? Um, what is the, the, the, the teamwork, uh, capacity, uh, how is, what is the ability of that team to get together and, you know, universally applies some of those structures, uh, within a student's day. And when those things aren't able to be accomplished effectively in, in the public school, then at that point, perhaps there are some additional considerations for placement that need to be made. Um, so it's, again, it's never, it's never something where I say this can't be done in a public school. When I, when I write reports, I say, this is what the student needs. This is what this individual needs. Um, if you can do it in the public school, great. If, if, but if you're not able to do so, then you need to consider a placement where that needs to occur.

Speaker 2: 7:38

Right. Right. And, and in your role of providing, uh, evaluations, educational evaluations, uh, you're often brought in to help determine what is the appropriate programming and where that programming should be, uh, implemented in a, in whether it be a public placement public school district placement, or a private placement. Right.

Speaker 3: 8:01

Correct. If that's a, if that's a question that the team has is to whether or not a public school or an outplacement is appropriate, then I will answer those questions for sure. And, um, you know, I'm always, uh, I always go in optimistically thinking that a school, a public school can do it. Um, I'm a big fan of public schools. So, um, nothing that I do in terms of my current practice, uh, or the development of prison Academy is because, you know, I don't believe public schools are, can't do it, but in certain circumstances, the match between the student's needs and the school programming just doesn't line up.

Speaker 2: 8:37

Right. Right. And, you know, oftentimes when I have this conversation with clients and potential clients, we get in, we get into the legalities of the least restrictive environment or the, or the acronym, the vernacular special ed alphabet soup LRE. Um, can you walk us through kind of the level of continuum from a clinician's perspective of the least restrictive environment?

Speaker 3: 9:05

Yeah. One of the things actually, as a, as a behavior analyst, one of our, um, ethical guidelines is, is least restrictive, but most effective, right? So there's a combination there. It can't simply be well you're in the public school. So that is the least restrictive environment. Therefore you need to be there. It's where is the least restrictive environment where the child can still access their educational services, where they can make the gains that they need to make. Um, so that's how I think about it. Um, and you know, a homebound instruction, right. Being, having the most restrictive setting you can be. And, um, you know, but if you're in a place and an out of district placement, again, like prison Academy, um, I wouldn't say that's a, a restrictive environment. It is, it is one where you do not have access to typically developing peers. Um, but I do. I think the mistake that people make when they talk about the availability or access to typical peers, is the assumption that children will just model peers or that they'll model the appropriate peers. Um, so the argument is often presented as well. We're going to place them in an inclusive general education setting, and they will have good peer models available to them in that classroom setting, which is true. However, you have to consider two things. One is the children who do the best, the models that you want kids to model often aren't getting the attention of the teacher or the people that you want to give them the attention, right? So the, the kids who are getting the attention tend to be the kids who may not be doing what they're supposed to be doing. And what's salient to the student who's supposed to be modeling in the classroom is okay. That seems to get the teacher's attention. And the teacher's attention is valuable to me. Maybe I'll spend some time doing what that kid's doing. Um, so modeling right, is, is again, no argument that kids model other kids' behaviors. It's just the question of, you have to direct them to model certain kids' behaviors. And you have to ensure that the peer models in the classroom know that they're peer models, right. Give them some it's valuable to them. Sometimes they really like that and say, Hey, can you help, you know, Johnny over here? You know, he he's coming to our class. Can you help them out? And you'll often find students who are really willing to do that, but no, ultimately though, again, at least restrictive has to be the most effective for that particular student.

Speaker 2: 11:40

Right, right, right. Um, you know, w one thing there's this cliche, I guess in special education law that parents of a child with a disability that are offered outplacement often don't want it and parents that want outplacement often don't get it. Um, can you kind of peel back that kind of cliche and, and how are you often getting involved with helping to determine what the appropriate programming should be when there is some contentiousness as to whether or not a child needs out placement between the child's school team versus the child's, you know, parent team.

Speaker 3: 12:24

Right, right. Yeah. I think a lot of the, the conundrum around that is really the, the, the perception of permanence of an outplacement from a school or from a parent, right. If I'm a parent and I want my child to be successful in a public school, and they're not being successful, AI, you know, there are certainly, I've worked with families as well. And there certainly can be the feeling of, well I've failed in some way or some manner. It's not, you know, not necessarily that the school has not provided these things, but I personally have, uh, I feel bad that this has happened. Um, you might have children with challenging behavior and the parents feel bad that, you know, there's been injury or a parent or other people that have been hurt or things like that. And, and then there's this permanence of, well, are you going to take him back? Are you going to take her back at some point, if, if you place them in this place, um, or they go visit those places that are being recommended. And maybe there are some things about that that you're, you're not comfortable with, um, as a parent. Um, and I think from the school side, it sometimes it's give us a chance or give us another chance or give us another chance. Or again, it's that permanence of how often does a child who gets out placed come back to district. Um, and I think one of the things that we're trying to address given that we work with a younger population is hopefully give us a couple more years, give us some time with this, this young learner to get them ready. And you'll have them for a much longer period of time, right. Rather than have them fail first or go in and fail and then have them come back or, or wait until they're older. And then you, you really lose a lot of time. You know, this is why we value early intervention. So much everybody values early intervention, um, and early intervention doesn't just mean age of child. It means as soon as there is a sign of risk, um, for something problematic, right. Uh, challenge, a challenging behavior that emerges in a, in a third grader where you want to address that early. Um, and again, not Mr. Gal place, but again, this is sort of the idea. So we've had these kids for this really intensive experience as very young children and, you know, maybe they just need a little bit more, you know, we have data that they're making progress and maybe just give us a little bit more time with them. And, and then they will come back. I don't, I don't, I don't know many parents who would say, um, you know, I know parents would say once they got to a place that don't want to go back to the public school, like, I mean, I get that, but, uh, a lot of parents would very much like their child to be in the public school, in their neighborhood school with people that they know and things like that. So, um, but yeah, I think it's that, that permanence piece that gets very, that's probably like it to be a real problematic, uh, I think from both parties. Yeah.

Speaker 2: 15:13

You raised a really interesting point and that is, you know, early intervention, right. We're supposed to be proactively a school team is supposed to be proactively looking to advance a child's progress year over year, rather than, you know, reactive where let's first have the child fail or not make progress and then respond to that failure. And, you know, from our conversations that we've had, this is where prism Academy is really looking to fill that void that, that Connecticut really has right now in our state let's talk, sped laws, the national podcast, but for the folks that are not Connecticut residents, can you go through and talk about the, you know, the student that prison Academy serves and, um, you know, kind of put it into like a, a clinical term. So for parents that are seeking a prism Academy, like program in their state, they know what they should be looking for because you're serving such a young population. Right. What, what, what what's the student that is, is kind of the ideal applicant, um, for consideration to your program at prism Academy?

Speaker 3: 16:32

Right? So in our first year of operation, we are really looking at a younger age group. So an elementary age group, we'd be focusing initially on our kindergarten through fifth grade type of students. Um, there are children with autism spectrum disorders or related disabilities, um, and they tend to be on the, what we would call diagnostically level two level three intensity in terms of their needs, both in both in their social communication and interaction in their restricted and repetitive patterns of behavior. So these are our children with fairly intensive needs, as far as their communication skills, their ability to navigate their environments, um, their routinized or rigid behaviors, or in some cases, stereotypic behaviors, um, and who require a good deal of support. Um, we also utilize, uh, applied behavior analysis. Um, so one of the things that we have to look for, you know, families who are, you know, obviously families who have been at prison before have experienced, uh, ABA quite a bit. And so they are very comfortable with that, but that would be something that, uh, should we get a referral from a school district? They, they, the recommendation would be that this child needs and a school that utilizes, um, educational practices based in the principles of human behavior. So, um, that's kind of what we're looking for at this point,

Speaker 2: 17:59

Right? So early on ABA intervention, um, with the goal that you're making the child more access ready to eventually, uh, potentially go back into public school setting, where they're going to have that, you know, more of the behavioral understanding, the social pragmatic understanding, um, that they would have not had had they continued the course in the public school system,

Speaker 3: 18:31

Right. It's sort of developing those prerequisite skills, those skills you need in order to get to that point. You know, I think there's a, again, another sort of big discussion or a big point you hear a lot is on readiness. Are they ready? You know, are they ready to do this? If you wait for someone to be ready, they're never going to be ready. Um, so we do try again, we're trying to be proactive here and say, let's develop those skills that align very much with the school environment, the general community, the home environment, right? And we teach to that. We teach to those environments, we don't teach skills to fit in a specific locale or, or only that exist within the walls of prison Academy. These are skills that we are developing that will bridge into those other settings that are generalizable. And we look for those things. We include parent training and our programming, so that parents will, we, we can check with, are you seeing this? You know, when we are talking about our educational planning, we're talking about generalization and maintenance of skills is part of our mastery criteria. This is what we're looking for. Um, we can't just say, well, you've achieved this at this level. You know, you've done 80% across a couple of days. Great. You're you're done. Um, no, we keep practicing. We keep doing it. We keep embedding it within the environments. Um, the other thing that we do at prism, uh, in general, right in our clinic and in our school is we use a lot of natural environment teaching a lot of, um, naturalistic and embedded instruction. So it's, um, it's one of those things that it's part of the, as the children are moving through their day there, these learning opportunities are presented within the environment, the environment itself evokes some of these responses. Uh, it's not just directed by, it's not just by an adult asking the kid questions all day. You know, they're playing with the child, they're engaging with them and, you know, and get embedding those, um, instructional opportunities throughout the entire day. Right

Speaker 2: 20:32

Now, the other thing that prism offers is then school-based consultation. So arguably if then one of your students is now access ready to be reintegrated back into their, um, their public school district. You and your team can then go back in to say, okay, we're going to transition the trial back. We're going to have some additional supports some school, a school consultation team to start to recreate and implement some of the programming that was done within prism Academy back into the school district. Right? Absolutely.

Speaker 3: 21:11

Yeah. And again, not to replicate a classroom from prison Academy into a public school is to say, here's what your here's, what your public school looks like. Here's how your school functions we're our goal would be to transition that student into that environment, not to necessarily replicate a w we don't want to stick a classroom that doesn't fit into a school building. Um, we want to make sure that student is able to navigate the, that school building or participate in that environment.

Speaker 2: 21:42

Right. Right. Now, as far as location goes, uh, prison Academy, it's in the greater Hartford area. Right. Yup. And, um, you know, you're you and the prison Academy team are looking for students, both from parent referrals as well as school district referrals, correct. Yep. Um, and can you, can you kind of walk us through how, um, the, the parent referral process is different from the school referral process for parents that are wanting to engage their district in a potential for all over to prison?

Speaker 3: 22:19

Yeah. So, uh, you know, if we have a parent that's interested in attending prison Academy, um, we would, you know, be looking to see how they're engaging or how they're going to support the tuition of, of attending an intensive program that we're providing. Um, certainly that's available. Um, although it's probably unlikely that a parent would fund that at their own expense, but, um, we would encourage most parents who are seeking that to come talk to us about our program, if they are comfortable with that, then we would sort of talk about the process of, of getting that done. Now, most of that then becomes a legal discussion, um, because it involves some contact with their school district, to which at which point I divest myself and say, I'm not an attorney. I do not give legal advice, nor should I, anything I say you should, you know, we'll get you into trouble. So, um, I would give them a several attorneys that they could talk to. Um, usually it's attorneys, some parents will say, Oh, I, uh, we'll talk about maybe an advocate or something. And, you know, um, generally they think it's best to consult with an attorney first. Um, and they may say you're good enough to go with an advocate that depends on their relationship with the school district. If you have one, um, or not, again, we're talking about a lot of younger children at this point who we're talking about, who some have been in schools before, um, and some have not. And, uh, I think the greater challenges for the ones who have not, I think I've talked about that a lot. Right. We just talked about it earlier. This is the idea that schools will want to sort of deal with that. But usually, yeah, usually either we tend to direct our families to have conversations with attorneys first, um, because we don't want to make recommendations about placement. Obviously that's not our, that's not our job. Um, all we do is present the program and ensure that the child is a, is a good fit and the parents think we're a good fit for them our first step. Right,

Speaker 2: 24:15

Right. Now, um, let's talk about, uh, you know, the, the approval process right now, prism Academy is going through that super exciting, by the way. Um, and, um, you know, the, the approval process is something for those that are, that are interested to know, it's, you know, you kind of pass the rigor and the accreditations, if you will, to be recognized by the Connecticut state department of education, special education division Bureau to be a program that is fit for the, for the children that you serve, which is, um, children on the spectrum. Um, how, how are we in that? How are you doing in that process? And when do you think that process will be achieved?

Speaker 3: 25:01

Yeah, that's actually a great question. I, we just had a conversation this week, um, with the folks at the state. Um, they've been really helpful in our, in our discussions. Um, we just started our program at the end of August. So essentially we are running a full school year, uh, so into June 180 days. Um, so when we finish our school year, we will officially have been in operation for a year and we will then submit our application, which includes, uh, binders full of, uh, policies and procedures and, uh, um, discussions about staffing. And do we have all the relevant staff and the right certifications and all of our appropriate background checks and those types of things. So, um, how are we developing our curriculum? So once we submit that, then the state reviews it and they do a site visit. And, um, our, we, we hopefully, um, ideally get approval. Um, we get a one-year approval, um, because that's, when you would have more of a, um, uh, contracts with the school system this year, we don't have any contracts with school districts because school districts, don't like to help place to schools that aren't approved, um, which we knew. And that makes sense. Um, so when we are approved and we have contracts, we'll then address any issues that arise in that, uh, site visit or the review of our application materials. And at the end of our second year, we get a, I believe it's a three, four or five year approval after that.

Speaker 2: 26:27

That's great. I mean, as I was mentioning before, it's so exciting to follow the growth of prison Academy. Cause there's not many schools that just grow and get created these days, especially during COVID. So, um, and certainly with your expertise at the helm and your past experiences, um, with the hospital for special care, I, you know, it's going to be, uh, it's going to be easy walking to get, to get approved. Um, um, confident, no doubt. Um, what is the, what is the, um, you know, the, the, the student to support, you know, staff support ratio that you're looking to, to do for the students that you're serving, um, within prison Academy?

Speaker 4: 27:51

Yes,

Speaker 3: 27:52

Right now we have 12 students and in our, in our program, we have, uh, two behavior analysts. We have a, uh, we have two teachers, um, a special education teacher. We actually have a teacher who is a, uh, uh, early childhood educator, special educator, and a, uh, regular education teacher grades one through three. So she has lots of excuse. She's also a behavior analyst. Um, so we're very fortunate to have a number of folks involved, uh, who are, uh, who are coming from a behavioral analytic framework. Um, and, uh, in addition, we have, uh, they receive related services, speech, and occupational therapies through some providers who are working within our building. They're not part of, they're not a part of prisons and Meltwater has medication in consultation, um, uh, speak ology and adapt and learn just because shout out to them because they're great. Um, and they are so, uh, as those children have come through prism of the clinic, they've also been working with these providers for speech and occupational therapy for, for several years as well. So there's some great continuity, um, and it allows us some good collaboration with, um, uh, the related services, uh, people as well. Uh, a number of our students have, um, augmentative and alternative communication devices. Um, so again, having that, um, collaborative opportunity with the folks who are providing those services and developing those, uh, communication, uh, structures is very helpful. So, um, yeah, so we're hoping to continue those, those ratios, uh, well at the high level of behavior analytics support with the high level of our educator supports, and, uh, ideally we continue to have educators who come in who have behavior analytic background. So it just makes that communication piece a lot easier. Um, and again, those folks who have a background in education just provide so much in terms of curriculum development and organizing our, our, our classroom structures and getting again that, that, that more naturalistic, that more school feel. But again, with a high level of intensity, as far as our instruction goes right now. Oh, and sorry, everybody has a one-to-one paraprofessional. Sorry. Um, and most of our, most of our technicians are, um, registered behavior technicians. Um, but they also receive a, uh, a lot of oversight by our behavior analysts, um, during the week. So, uh, most of our children receive about four hours per week of, um, oversight by a behavior analyst. So, um, I think you'd be challenged to find that level of support in a lot of other settings. Yeah,

Speaker 2: 30:33

Yeah. Now, now COVID is certainly thrown a wrench in our entire education system, obviously. Um, how is it starting school during the pandemic?

Speaker 3: 30:46

Yeah, well, um, we had had some good systems of support in place when the pandemic started, as far as the clinic goes. A lot of, um, we had made some transitions as far as where, um, our learners were receiving their instruction and we had a few learners that would really benefit from remaining in the clinic, remained in the clinic. Um, as our safety precautions, uh, developed towards the, uh, over the summer, we started to return more of our learners back to the center. So most of the students who were, who started prison Academy were of that group that were still receiving clinic-based services, um, throughout the early parts of the pandemic, again, because they were the, um, the students who had the most significant needs. Um, so we just continued on, uh, during the fall, um, where we monitored every day, we checked in with our parents about their, how they felt, how their children felt. We were very conservative as far as, um, any sort of, um, you know, stuffy nose, cough, sneeze, you know, w our staff would, would, we would not have them come in. We would have, we had several staff who were probably been tested four or five, six times already, um, just to be safe. And, you know, uh, I will knock on wood here. We've been very successful, um, and not having any, um, high levels of, uh, spread. Certainly since prison Academy started, we've had some, uh, community-based exposures, but none of that has occurred in the school building itself. So, um, we continue to operate, um, with all the relevant precautions, um, are luckily, um, since we are, uh, prison is a medical facility, uh, the clinic part is, um, we were all able to get our vaccinations, uh, started earlier. So we're, we're number of us on that, uh, on that track already. So, uh, you know, I think we did, you know, as, as with everybody, we've really followed the recommendations of our local health department, the CDC, and, and all those, those guidelines as they've developed and changed over time. And now there's been pretty, we've been pretty successful in that.

Speaker 2: 32:58

That's great. That's great. Well, Dr. John[inaudible], thank you so much for being on the show today. Uh, now for folks that are interested in learning more about prism, uh, uh, both their clinical division, as well as prism Academy, uh, the website is prism autism.com and, uh, Dr. John Molton, his information is also on there. If you're interested in speaking with him and seeing if your child is the right fit for their program. Uh, John, thank you so much for being on the show. And, um, I look forward to continuing to, uh, to, to have prison be part of the Connecticut special education community. And, uh, it's very exciting that you're starting a new school. So congratulations on that.

Speaker 3: 33:45

Thanks, Jeff. We're uh, very excited about this next part of our, uh, our growth.

Speaker 2: 33:50

Thank you. All right, everyone.

Speaker 1: 33:52

Uh, thank you so much again for listening to another episode. Let's talk sped law. We'll see you on the next show.