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10

What Is A Representative Payee?

By | NESCA Notes 2020

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

Your child has turned 18. The application for Supplemental Security Insurance (SSI) has been submitted and approved. You’ve been assigned to be the representative payee to manage the SSI funds. How can you still help your child gain money management skills while managing the responsibilities as required by the Social Security Administration (SSA)?

What is a Representative Payee?

Many individuals with disabilities can safely and successfully manage their finances without assistance. However, due to their disability’s nature, many individuals are unable to manage their finances without help. In response to individuals who need assistance to ensure their needs are being met through their benefits, the SSA created representative payees. A representative payee is a person or organization assigned by the SSA to be responsible for the benefits that a person receives from the SSA and ensures that the beneficiary’s needs, such as housing, food and medical care are met. A representative payee can be a family member, friend or another person. When the representative payee is an organization, there is often a fee (determined by the SSA), but when the payee is a friend or family member, the payee provides this service at no cost to the beneficiary. The representative payee will make a budget for the beneficiary to ensure basic needs are met and provide money for savings and personal spending if funds allow.

A representative payee is responsible for tracking and keeping detailed records of how the funds are spent and must provide those records to the SSA when asked. Many payees also need to fill out an annual reporting to the SSA detailing how the funds from the previous year were used. Recent changes in the law amended who needed to fill out such reports. Now, parents and spouses who are representative payees and live with the beneficiary no longer need to fill out the annual report. However, they do still need to keep detailed financial records.

How can I support my child’s financial literacy as their representative payee?

I have been a representative payee for individuals with disabilities for the vast majority of my career. In that role, I also worked to increase the individual’s financial literacy skills and increase their understanding of their financial situation. Having the individual involved in the process has innumerable benefits, the most basic of being the respect for their human rights. By having the individuals involved as much as they are capable and is healthy for them, much of the animosity and much of the paternalism of having another person control their finances, can be dissipated. Some individuals will still choose to have minimal involvement in their finances due to anxiety, comprehension or individual priorities. But most will want a say. By meeting your child where they are in their financial journey, you can build their confidence, independence and autonomy.

The first step I like to take in building an understanding around finances is helping the person comprehend where their money is going. Maybe that will be showing your child a bank statement. Perhaps it will be showing receipts. For many young people, the amount they receive in SSI seems like a lot of money. Helping them understand the value of the funds they receive can be one of the most challenging tasks.

Another activity I like to do with the beneficiaries I assist is asking them to create their budget. How would they like to see their money spent? What are their financial goals? Do they want to live on their own someday? How much do they want to set aside for savings for more significant expenses or purchases, like first, last and security deposit; a car; a vacation? Below is a very basic budgeting form I like to use as a starting point.

Beneficiary Budget Month Year
Income
SSI $783.00
MA State Supplement $114.39
Total Income: $897.39
Expense
Rent $265.00
Groceries $200.00
Transportation $55.00
Electricity $60.00
Cable $105.00
Cell Phone $75.00
Medication $15.00
Personal Spending $75.00
Savings $25.00
Total Spending: $875.00

Within the last few years, ABLE accounts have been getting a lot of press – and for good reason. For individuals who became disabled at birth or at a young age, an ABLE account is a wonderful way for the individual to save money for important needs and not have those assets affect the essential financial and healthcare benefits they need. The IRS recently updated the rules for ABLE accounts. In the resources below is an article from Disability Scoop with information about these updates.

One of the best ways to increase your child’s money management skills is to have them be responsible for portions of their money. They are many ways to do this, and it may take some trial and error to find the best way for your child. It is important to remember that you are not allowed to give the beneficiary direct access to the bank account as the representative payee. That means you cannot just hand over the debit card to your child. However, many companies offer programs that help young people (and adults) manage their money. I tend not to use the word “allowance” for adults when managing their money. Instead, I use words like “personal spending” or “Flex Money.” Whether I write a check to the individual for these funds or reload a prepaid debit card, giving the individuals the remaining money after necessities have been met gives them the freedom to make their own spending choices, whether good or bad. And yes, I have worked with individuals who were without personal spending money within days of receiving their excess funds for the month. Still, I have worked with individuals who have, over time, been able to build some savings and a greater understanding of money management. I have listed some in the resources, but these are not ones I have personally used, so please review and see which ones you think would work best for your family.

Another method that I find beyond useful to help build financial independence and assess current money management skills is to transfer the responsibility of paying a bill over to the individual. This should be a lower priority bill, like the cable bill, a streaming service or a cell phone bill. As time goes on and the person can pay the bill on time without prompts, increase the number of accounts the person is responsible for paying. As they build their financial independence, increase their personal spending to include funds for necessities, such as groceries and prescription copays. And remember, once a person has a representative payee, it does not mean that they must have one for life. Suppose your child is able to build the financial management skills necessary to manage their finances independently. In that case, a representative payee can be removed. If your child now has the skills to manage their own money, talk to one of your child’s providers. They can fill out a form to return this right to your child.

Have you been working with your child on money management skills? How have you fostered financial independence?

 

Resources:

Social Security Administration Representative Payee Webpage

Disability Scoop: IRS Issues Final Rules on ABLE Accounts

The Balance: The Best Debit Cards for Teens

Capital One MONEY Account

Dough Roller: Best Prepaid Debit Cards for Teens

FAQs for Beneficiaries that have Representative Payees

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

10

Voting Support for Individuals with Disabilities

By | NESCA Notes 2020

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

General Election season is upon us. The major-party national conventions are over, and the Massachusetts primary results are in.

About 20% of eligible voters have a disability, but only 49.3% of individuals with disabilities voted in 2018. And that was an 8.5% increase from previous years among this increasingly important voting bloc. Campaigns, such as the REV UP Campaign by the American Association of People with Disabilities (AAPD), have launched voter registration drives, championed for disability rights and policies to be part of the political conversation, and to increase awareness and action to remove barriers that make it challenging for individuals with disabilities to vote.

So how can we help our young people with disabilities exercise their right to vote? In Massachusetts, even individuals with guardianship maintain their right to vote unless the court documents specifically state otherwise. There are many ways to support individuals, but it starts with helping them register. Massachusetts residents can register to vote online, when obtaining or renewing a driver’s license or state ID, or at the local registrar of voters’ office. Notices from MassHealth and the DTA also include voter registration forms.

Absentee/mail-in ballots have been in the news more than ever due to the pandemic. Still, they have long been an excellent strategy for individuals with disabilities who would have difficulty voting in person. Absentee ballots are a great option for individuals who may have difficulty navigating the multiple steps in person or have a lower processing speed.

All citizens are also allowed to bring a person to help them while they are at the polls. Encourage your young person that many people require assistance at the polls, and it is completely normal to have the help available if they need it. Each polling location should also have at least one AutoMARK Voter Assist Terminal, which helps individuals with visual impairments vote independently.

No one wants their vote not to be counted due to errors filling out their ballot. People can request a sample ballot in advance from their local registrar of voters (the Secretary of State’s website can give you the address and phone number of your local registrar). Practicing filling out ballots in advance (even ballots from previous elections) can help a new voter become comfortable with the form and is great fine motor skill practice for those who may need it!

The Massachusetts Secretary of State also creates a voter information booklet for each election regarding the ballot initiatives. These red booklets can be found at many community locations and frequently include the local library, post office and city/town hall. These booklets offer information on what a yay or nay vote would mean and have information from each initiative’s proponents and opponents. Use that sample ballot as a starting point for the different types of elected positions.

Help your young adult find out what the different boards do and why there is an election for things such as town selectman or zoning board. Help your young adult find the websites for candidates running for office and review the candidates’ stances on issues. Ask what issues they want to learn more about and are important to them.

Most importantly, remind them that their voice counts. As many disability rights activists have said, “nothing about us without us.” Individuals with disabilities are greatly affected by the policy decisions that occur in government at all levels. Since many individuals with disabilities have frequently experienced disenfranchisement, there are numerous groups working tirelessly to lessen and remove these barriers. How have you helped your young adult exercise their right to vote?

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

9

What In-person School Looks Like During COVID-19

By | NESCA Notes 2020

By: Tabitha Monahan, M.A., CRC
Transition Specialist/Counselor

Fall is approaching, and school is starting. As a student, I always knew summer was close to ending when Staples started their “Most Wonderful Time of the Year” commercial. The joy that parents and the community feel as fall approaches and another year of learning begins is understandably absent this year. Many parents, teachers and students are still unsure if they will be remote, in-person or both. All are too aware that even if students and teachers return to the school building, school will not look as it did in the fall of 2019. The comradery that our children experience through recess and interactive group work will be limited. Lunch will not be the boisterous room of students comparing who is in each class and what teachers are giving homework the first week.

What can we expect then–especially our students who need the small in-person support they have received from their special education teachers, teaching assistants and related service providers? I was able to get a glimpse of what our new in-person normal would look like providing vocational counseling and support during an extended-school year (ESY) program this summer. When returning to school, the first thing I learned—remembered, is how resilient children are. Most students in the programs had very few issues with masks. For those who did, more frequent mask breaks and workarounds, such as face shields, greater distance between them and other students or neck scarves let them still participate in much needed in-person support. Hand-washing and sanitizer have become the norm, and staff and students had frequent opportunities to use both. Social Skills groups still occurred but were modified to continue to be possible. Community-based opportunities were limited, but again, teachers and service providers have long been accustomed to finding out of the box solutions for their students.

Yes, the first day was nerveracking. How were the students going to tolerate wearing a mask for hours on end? How were my co-workers and I going to wear a mask all day long? How was I going to get a drink safely while wearing a mask? But we did. Staff and students alike remained diligent with hand-washing, and the students were ready to learn. Teachers and teaching assistants (TAs) were available and came together for short periods to help students understand challenging tasks. Some of our children and students have behaviors or need activities of daily living (ADL) support that may have us more uneasy with their health and safety returning to in-person learning. Teachers and TAs were prepared for that, too. Whether it was a face shield with a mask, an extra set of clothes to change into or an additional layer of PPE, the student’s needs were met, and we all returned the next day.

Every district seems to have its own approach and plan. Still, in the end, each plan’s goal is the same: have every student continue to learn and prepare for life after high school and have each person return home safe and healthy.

 

About the Author

Tabitha Monahan, M.A., CRC, is an experienced transition evaluator and vocational counselor. While she is well-versed in supporting a wide range of transition-aged youth, she is especially passionate and knowledgeable in helping clients and their families navigate the complex systems of adult services and benefits as well as medical and mental health systems. She is further adept in working individually with students of all abilities to empower self-advocacy and goal achievement.

 

To schedule an appointment with one of NESCA’s expert transition specialists or neuropsychologists, please complete our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

18

Processing Speed Deficits and College – Part 2 – Finding a Fit

By | NESCA Notes 2020

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

In my last blog, Processing Speed Deficits and College – Part 1 – The Dilemma, I discussed specialized instruction for students who have processing speed deficits in high school in comparison to the accommodations process in college. Below is a list of some of the accommodations and instructional modifications that are often afforded to students with processing speed deficits in high school, and if/how that support can be replicated in college as well as how hard a student may need to work to bridge gaps in support. One of the most important things to remember when reviewing this list is that modifications to the course of study or workload in a college course are typically not available in college. Students with processing difficulties must be able to keep up with the same instruction provided to every student in the class through a combination of accommodations, self-help strategies and use of supports (tutoring, academic coaching, office hours, study groups, etc.) outside of the classroom.

In the classroom

  • Reduced pace for instruction – High school educators may be used to heavily modifying their instruction (i.e., providing instruction at a slower pace, in manageable “chunks,” sometimes even with breaks between content) when they are teaching a class that includes students with reduced processing speeds. This is a typical methodology for many private special education schools and for special education classes in public schools. However, this is not the typical instructional style at a traditional college. With that said, there is great variety in the pacing of classes from one institution to another, and even from one teacher to another within the same institution. For students who have received specialized instruction in high school, it is important to consider the pace of available instruction and to sit in on college classes when considering this transition. Depending on the student’s learning profile, it may be necessary to seek out a college or support program that is specifically designed for students with learning disabilities or has had targeted programming for students with learning disabilities—especially those with processing speed deficits—for many years.
  • Copies of teacher notes or fill-in-the-blank notes – Note-taking is an important skill for life, and even students who receive accommodations to enhance their note-taking need to build skills for retaining instruction and oral direction. However, some students exit high school without note-taking skills. Upon request, colleges often have one or more ways that they can accommodate students who are unable to effectively take their own notes in class. Students may be able to get copies of teacher notes/slides, copies of notes taken by another designated student or professional note taker, recordings of class or opportunities to use other technologies in class, such as a Livescribe Smartpen. When note-taking is a challenge, it is important to understand what accommodations are typically available at a particular college, including what support might be provided for assistive technology training and usage.
  • Follow-up questions and review of learning – Students who have difficulty processing classroom learning in real-time are often provided lengthy opportunities to ask questions about materials outside of class and/or provided with copies of the teacher’s lecture materials and study guides for separate review. When thinking about college, easy access to course information and resources from outside of the classroom is an important consideration. While many universities and professors use learning management system (LMS) technologies like Blackboard, Canvas, Google Classroom, etc., there are still some professors who have not made the shift to using these systems for the majority of their coursework or student communication. Getting a sense of technology use is important if a student expects to preview and review course materials outside of the classroom (independently or with support). Understanding how easy it is to get ahold of professors outside of class (e.g., percentage of faculty who work full-time at the school, have offices, have office hours), and how to schedule brief times for individual communication with the instructor is also useful.

Managing assignments

  • Reduced writing – In high school, students who struggle with processing speed may be expected to complete fewer assignments or have longer deadlines than typical peers. In college, students are expected to complete the same number of assignments and to have all of their work for each course completed by the end of the semester. It is possible at some colleges to request extensions on assignments as an accommodation or on a case-by-case basis. However, extensions on assignments should be something that are needed as an exception rather than a rule or students may find themselves unable to keep up toward the end of a semester. Instead of extending deadlines, students who struggle with writing demands may benefit greatly by taking a reduced course load (i.e., fewer classes per semester) or by diversifying the types of classes they enroll in during one semester—for example, taking a kinesiology class at the same time as an English Composition class. If these types of accommodations are important, students will need to carefully understand a school’s policies on underloads as well as how much control/flexibility a student is able to have when managing their course of study.
  • Grading based on quality not quantity – Just as described above, it is important to remember that every student in a college course is expected to complete the same quantity of work and same course requirements. Both quality and quantity matter in college and for those reasons it is important to pick a school that is well suited for your pace and style of learning as well as a major that will enable you to fulfill course requirements using your learning strengths.
  • Support with reading fluency – Specialized instruction during K-12 education may have focused on helping a student to increase their reading pace. Reading intervention and readers are not typical in college. However, technology can be a lifesaver in supporting a student’s independent reading fluency. Students may benefit from audio books or from text-to-speech technology so that they can take in information in multiple modes and a faster pace. Practicing with technologies and understanding the related accommodations that will be available in college are important for continued reading success. Some high school students have additionally needed tutoring support because they learn best when discussing aloud content that they have read in a supportive setting—for those students, it has been important to seek out schools or learning disability programs that can provide this type of tutoring (a less common support) or to pay privately for tutoring in addition to college-based learning supports.

Testing

  • Extra time – This is one accommodation that is fairly common in both high school and college settings. One major change is that many high schools provided unlimited extra time to students, even those with no identified learning disabilities. In college, students will typically receive 50% or 100% extended time based on their needs as demonstrated in diagnostic testing. Good executive functioning can be helpful if you are a student who uses extra time on exams, because you may need to schedule your exams in a separate testing setting each time they occur.
  • Shorter length/Reduced writing requirements – As a college student, you are required to meet the same testing requirements as every student in your class. If you are accustomed to reduced writing requirements on tests, you will need to consider some of the other available accommodations (e.g., extra time, assistive technology, etc.) to successfully manage. You may also need support building your test taking strategies so that you can use your time most efficiently on tests.
  • Separate testing space – Taking a test in a reduced distraction environment, or possibly a private room, is another accommodation that is common in both high school and college. Similar to students who receive extra time on tests, there can be a high degree of planning and organization involved in scheduling one’s exams in a separate setting according to school guidelines. Students may want to inquire about the level of support that college personnel will provide to a student when they are first learning to organize and implement their testing accommodations.

Social and daily life

  • Two additional factors that may have been important in high school include Smaller school/class size and Similar peer cohort. Matriculating from a small homogenous class or school environment, where all of your peers have similar learning styles and accommodation needs, can be a shock. When researching and visiting schools, it will be extremely important to get a sense of who the other students on campus are, how common processing speed deficits are among students with learning disabilities on campus, how diverse the school is and how tolerant students generally are, etc. Sitting in on classes and taking part in accepted student days can be critical activities for students who are looking for a college that will meet them where they are at.

When students enroll with disability support services, they are often asked how their disability impacts their learning, what accommodations they were provided in high school, and what accommodations they think they will need. For students with processing speed deficits, it is critical to be able to answer these questions before beginning a college search and to find colleges that truly match their learning needs as well as their more general wishlist!

 

 

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

10

“Doomscrolling” and Creating Space for Gratitude

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

A recent article in the New York Times (July 15, 2020) discusses a newly coined term for a coping strategy that has become pervasive amidst all the uncertainty: “Doomscrolling.” In the article, doomscrolling is defined as, “…the experience of sinking into emotional quicksand while bingeing on doom-and-gloom news.” It has become so common, it has a name.

We are collectively experiencing a great deal of anticipatory anxiety, which occurs when we feel anxious or stressed about an event that will happen in the future. We know there will be an event, but we do not know when or what that event will be. For those who participate in doomscrolling, perhaps it is an effort to find a sense of certainty. If we know what is coming next, it helps us feel more in control. However, while doomscrolling may provide a short-term sense of control, like many maladaptive ways of coping, it will eventually take a toll on our mental and physical well-being. Several wonderful suggestions are offered in the article and a follow-up piece to deal with doomscrolling. Another positive strategy for coping with anxiety and stress is practicing gratitude.

According to the National Institutes of Health, early research suggests that a daily habit of practicing gratitude may improve emotional and physical health. Practicing gratitude reduces stress and anxiety by regulating stress hormones in the brain. It also enhances the production of dopamine and serotonin, two neurotransmitters responsible for our emotions and sense of well-being. Practicing gratitude can be as simple as taking a moment to appreciate a good cup of coffee or a refreshing breeze on a hot day. There are many ways to create space for gratitude:

  • Take a few moments each day to write down as many things as you can that you are grateful for
  • Try to notice positive moments as they are happening
  • Compliment yourself each day and say it out loud
  • Keep a gratitude journal that includes: Compliments that you give yourself, current challenges and what you are learning, people you are grateful for, and significant assets of your life right now.
  • Start a gratitude jar with your family where each person writes one thing they are grateful for that day on a slip of paper and adds it to the jar. The notes can be read aloud at the start of each new week.

For further reading check out these articles:

https://www.nytimes.com/2020/07/15/technology/personaltech/youre-doomscrolling-again-heres-how-to-snap-out-of-it.html

https://www.nytimes.com/2020/07/16/technology/coronavirus-doomscrolling.html?searchResultPosition=2

https://positivepsychology.com/neuroscience-of-gratitude.

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

18

Processing Speed Deficits and College – Part 1 – The Dilemma

By | NESCA Notes 2020

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

By nature, transition specialists are generalists—professional who support students with a wide range of disabilities in moving toward an even wider range of learning and life outcomes. Working in Massachusetts, with an early background as a guidance counselor in a college preparatory high school, I often support students who are contemplating whether and when they should matriculate to a four-year college program. Many of these students experience processing speed deficits. This means that these students may be capable of reasoning at average or above average levels, and therefore being stimulated and actively engaged by college course content, but these students also need extra time to process visual and verbal information, to make sense of this information, and to produce output.

Landmark College in Putney, Vermont, assembled an assessment for parents and students—A Guide to Assessing College Readiness—that includes five areas considered essential for students with learning disabilities who want to succeed in a traditional college setting. These include academic skills, self-understanding, self-advocacy, executive function and motivation/confidence. Some of the academic items include being able to read up to 200 pages of college level text in a week, writing an organized 10-page paper that cites multiple sources, and being able to complete all of the steps of a long-term project in a timely manner. Within the assessment, it is carefully noted that this is not a diagnostic tool and is intended to inform discussion about the appropriate environment and supports that the student will need to achieve success and struggle less in college. So, when I recently received a question from a parent who was wondering if it actually mattered that her student was not able to read 100 pages in only a few days, the answer I provided was, “it depends.”

While there are many ways that we accommodate and modify instruction for students who have processing speed deficits during high school, some of these methods are easy to replicate across college environments and others are heavily dependent on the environment or only replicable with a good deal of external support provided by people and technologies. For example, in high school, students with significant processing speed deficits may be supported through accommodations, such as teachers reducing their pace of instruction, providing copies of instructional materials and/or fill-in-the-blank note-taking templates, actively following up with students to confirm their understanding of material, and actively assisting students in digesting complex reading materials. They may also receive modifications such as reducing the amount of work a student is expected to do per quarter or on a test and offering lighter or alternative reading. When all of these accommodations and modifications are added together, a student has a highly specialized high school experience and may be left with gaps in their academic, executive functioning and self-advocacy skills that need to be carefully bridged when the student aspires to participate in college learning.

While high school accommodations and modifications center on supporting a student to successfully make progress in school, accommodations at the college level focus exclusively on what a student needs to be able to access the instruction that is already available at that college. Rather than individually modifying the curriculum or work load in a college course, a student must be able to keep up with the same instruction provided to every student in the class and the same requirements as every student in the college through a combination of accommodations, self-help strategies and use of supports (tutoring, academic coaching, office hours, study groups, etc.) outside of the classroom. Accommodations are still very individualized, but educational programming is typically not. This makes the college search and selection process complex and important for students with processing speed deficits. Not every college that specializes in supporting students who face learning difficulties is a good choice for a student with slow processing speed. And not every student with a processing speed deficit has the same skills, or faces the exact same challenges, when navigating college.

Stay tuned for our next Transition Thursday blog where I will elaborate on some of the common modifications and accommodations provided to high school students with processing speed deficits and how to think critically about college selection, support and accommodation based on experience with those accommodations.

 

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

16

Positive Coping Strategies for Stress, Anxiety and Trauma During Times of Crisis

By | NESCA Notes 2020

By Renée Marchant, Psy.D.
Pediatric Neuropsychologist

Amidst the global pandemic, children, their caregivers, their teachers and therapists are naturally experiencing heightened stress and anxiety. We are more likely to be sent into “fight, flight, freeze, mode” – the body and brain’s critical survival strategy to prepare and deal with perceived threat. For example, when you see a Grizzly Bear on your hiking trail, you instinctually run, fight back or hide.

However, we can become “stuck” or more sensitive to this instinctual urge, which is not adaptive and can negatively impact physical, emotional and social health. For example, chronic deployment of the “flight, flight, freeze” response occurs for individuals who experience post-traumatic stress disorder. Chronic deployment of “fight, flight, freeze” responses is also more likely amidst a global pandemic, such as COVID-19. Importantly, chronic deployment of “fight, flight, freeze” responses also occurs for individuals and communities who experience chronic racial injustice and oppression.

Under chronic experiences of stress and threat, our body remains activated and hyper-aroused, even when deploying this response is not helpful. For example, children may shut down or dysregulate when faced with even small stressors – making an error on a math worksheet or even accidentally spilling something on the table. Children and teens may be more irritable, defiant or isolative. Overall, chronic deployment of the “fight, flight, freeze” response heightens anxiety, stress and general feelings of malaise.

So, what can we do? What can we do to “turn off” or lessen this stress response? What are some ways to positively cope during these difficult times?

  1. Research shows that the #1 resiliency factor is the reliable presence of at least one supportive relationship with an adult. Build connection and community through shared activities and conversations about your experiences. Remember to always take care of yourself before taking care of others – self-care is critical.
  2. Focus on validation first; problem-solving second. Validating, acknowledging and accepting pain, distress, hurt and the like builds communication and naturally decreases tension and stress. Validation is the essential first step prior to action, problem-solving and positive coping.
  3. In order to grow positive coping, it is helpful to build mastery and self-expression. Strategies that can help to both organize and “release” feelings and stressful experiences rather than “bottle them up” include:
  • Use your body to heal your mind: play, do yoga, engage with nature, exercise;
  • Engage in shared action to promote communication and change at a community and systemic level. Volunteer or advocate for a cause of importance. Contact your local legislators and express your concerns;
  • Write or draw about your experience. Use collages, images or videos to express your goals, experiences and fears;
  • Engage in therapeutic movement. Create a music playlist for various emotions. Dance or engage in rhythmic actions (e.g. knitting, pottery);
  • Identify your strengths and what you value in life. Happiness is fleeting – goals and values last longer and support positive coping. For a free strengths and values survey, check out: https://www.viacharacter.org/;
  • Connect with community resources available in your area, such as therapists, mentors, religious organizations, support groups, local-nonprofits, etc.; and
  • Be kind to yourself and practice self-compassion.

To learn more about this topic, a helpful webinar is available at “Supports for Students with a History of Trauma and Significant Anxiety,“ presented by Dr. Renee Marchant, PsyD, and Dr. Stephanie Monaghan-Blout, PsyD.

 

About the Author:

Dr. Renée Marchant provides neuropsychological and psychological (projective) assessments for youth who present with a variety of complex, inter-related needs, with a particular emphasis on identifying co-occurring neurodevelopmental and psychiatric challenges. She specializes in the evaluation of developmental disabilities including autism spectrum disorder and social-emotional difficulties stemming from mood, anxiety, attachment and trauma-related diagnoses. She often assesses children who have “unique learning styles” that can underlie deficits in problem-solving, emotion regulation, social skills and self-esteem.

Dr. Marchant’s assessments prioritize the “whole picture,” particularly how systemic factors, such as culture, family life, school climate and broader systems impact diagnoses and treatment needs. She frequently observes children at school and participates in IEP meetings.

Dr. Marchant brings a wealth of clinical experience to her evaluations. In addition to her expertise in assessment, she has extensive experience providing evidence-based therapy to children in individual (TF-CBT, insight-oriented), group (DBT) and family (solution-focused, structural) modalities. Her school, home and treatment recommendations integrate practice-informed interventions that are tailored to the child’s unique needs.

Dr. Marchant received her B.A. from Boston College with a major in Clinical Psychology and her Psy.D. from William James College in Massachusetts. She completed her internship at the University of Utah’s Neuropsychiatric Institute and her postdoctoral fellowship at Cambridge Health Alliance, a Harvard Medical School teaching hospital, where she deepened her expertise in providing therapy and conducting assessments for children with neurodevelopmental disorders as well as youth who present with high-risk behaviors (e.g. psychosis, self-injury, aggression, suicidal ideation).

Dr. Marchant provides workshops and consultations to parents, school personnel and treatment professionals on ways to cultivate resilience and self-efficacy in the face of adversity, trauma, interpersonal violence and bullying. She is an expert on the interpretation of the Rorschach Inkblot Test and provides teaching and supervision on the usefulness of projective/performance-based measures in assessment. Dr. Marchant is also a member of the American Family Therapy Academy (AFTA) and continues to conduct research on the effectiveness of family therapy for high-risk, hospitalized patients.

 

To book an evaluation with Dr. Marchant or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

18

Transition Planning Timelines for Students with Disabilities

By | NESCA Notes 2020

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

When families come to NESCA for transition support, a common request is to work with a transition specialist to create a detailed step-by-step transition plan with action items and deadlines that will ensure their child makes a successful transition to postsecondary adulthood. As you can imagine, many hours are needed to create an appropriate plan individualized to the student—their goals and their needs—and this plan requires frequent updating as students progress toward adulthood, have new experiences, stumble at new hurdles and make developmental leaps. However, for families who are interested in creating an individualized transition timeline plan for their student at home, there are a number of readymade timelines and checklists that can be used as starting points. While I am presenting several options below, I would encourage picking the one that you like best and that fits your child best, and using that as a foundation for your planning. Please note that even though the resources below that have been assembled by agencies who specifically support individuals with autism and are therefore described as focusing on autism spectrum disorder (ASD), they may still be important for individuals with other disabilities to review.

Transition from School to Adult Life – Time Lines, by The Arc of Massachusetts, is a two-page brochure that includes bulleted timeline recommendations for students ages 13-22

A Resource Guide for Transition Aged Youth and Young Adults with Autism Spectrum Disorder (ASD), by the Autism Commission, is a 12-page pamphlet compiled to help families and individuals in the state of Massachusetts to better understand the resources available for students aged 14-22 with ASD. If viewing this pamphlet online, it is important to closely follow the page numbers. The Transition Timeline starts on page two and continues through page four.

Transitioning teens with autism spectrum disorders: Resources and timeline planning for adult living, by the Autism Consortium, is a 73-page guide intended to provide resources and information for parents and guardians of children with ASDs in Massachusetts. Pages 64-70 outline critical timelines related to education, guardianship, housing, postsecondary education, employment, healthcare, recreation and more for students ranging from age 11-22.

A Family Guide to Transition Services in Massachusetts, published by the Massachusetts Rehabilitation Commission (MRC) in collaboration with the Federation for Children with Special Needs (FCSN), is a 44-page guide intended to assist parents, students and professionals in understanding the requirements of transition services for all individuals with disabilities that are eligible for special education in Massachusetts. Pages 22-23 offer an easy-to-read timeline covering important steps for youth ages 14-18.

Important Transition Information Every Family Should Know: Transition Information Fact Sheets, by the Massachusetts Department of Developmental Services, is a 44-page compilation of fact sheets with important information for all families of individuals with developmental disabilities in Massachusetts. The fifth fact sheet, on page 9, is a simple but detailed visual timeline covering steps for students ages 14-22.

Turning 18 Checklist, by Autism Housing Pathways, is not a timeline! But it is a detailed and continually updated three-page document with a checklist of critical steps to take when a student with a disability turns 18 as well as a list of useful transition resources that correlate with the checklist. While the document was created by Autism Housing Pathways, the checklist is applicable for many individuals who are turning 18 and who may be seeking human service supports and disability-related benefits.

 

If you are interested in working with a transition specialist at NESCA for consultation, coaching, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

18

Making Decisions in Adulthood: Some Options

By | NESCA Notes 2020

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist

As a transition specialist working with students from middle school through young adulthood, one of the biggest transitions that students make is “turning 18” or when they reach the Age of Majority (i.e., the legal age established by state law at which the person is no longer a minor) and gain the rights and responsibilities for making educational, medical, financial and other legal decisions. For students who have had a tremendous amount of support at home and in school, this transition can be challenging. Some students are not ready to make competent decisions for themselves, and other students may never be capable of making competent and informed decisions independently. If your child or a student you are working with needs help making decisions in adulthood, there are several options for organizing decision-making in adulthood. Because I am not a legal agent, I do always suggest that families consult with experts, such as special needs attorneys, financial planners and medical experts, as they work toward determining the best legal decision-making arrangement for their child.

Here are some basic descriptions of decision-making options you may consider for your child:

Power of Attorney (POA): A written authorization that allows a person to represent or act on another’s behalf. There are different types of POAs, and they can be written specific to whatever acts the individual wants the agent to be able to perform (e.g., private affairs, business, financial, medical or some other legal matter).

Health Care Proxy: A legal instrument with which the individual appoints a healthcare agent to make healthcare decisions on behalf of the individual when he or she is incapable of making and executing the healthcare decisions stipulated in the proxy. One way this is different from a POA is that the healthcare agent is only able to make medical decisions for the individual during the time when that individual is incapacitated. However, some healthcare professionals may view a healthcare proxy as a desire to share medical decision-making even though that is not exactly the letter of the law.

Guardianship/Conservatorship: A court-ordered arrangement whereby one or more persons are given legal authority to make decisions on behalf of another person. Guardianship and conservatorship are used when the person’s decision-making capacity is so impaired that the person is unable to care for his or her own personal safety or to provide for his or her necessities of life. Guardians and conservators may have limited decision-making power or general broad control. While POAs and health care proxies are arrangements that might be considered mainstream as they can be accessed by any adult with or without a disability, guardianship and conservatorship are more extreme options as a guardian is taking full or partial control over an individual’s affairs and taking away some of that person’s legal and civil rights.

Supported Decision-Making (SDM): SDM is an alternative to guardianship whereby the individual with a disability selects supporters who will assist the individual in making their own decisions. It allows an individual with a disability to make his or her own decisions about life choices with the support of a designated person or team of trusted supporters. This is an alternative to guardianship which is becoming more popular in Massachusetts and many other states across the country. To learn more about SDM, check out the National Resource Center for Supported Decision-Making and the Supported Decisions Site from the Center for Public Representation.

If you are looking for more information about special needs legal planning specific to Massachusetts, these are a handful of resources you may want to explore:

 

If you are interested in working with a transition specialist at NESCA for consultation, coaching, planning or evaluation, please complete our online intake form: https://nesca-newton.com/intake-form/.

 

About the Author:

Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

10

How to Talk to Your Kids about Racial Inequality and Current Events

By | NESCA Notes 2020

By: Cynthia Hess, PsyD
Pediatric Neuropsychologist Fellow and Therapist

It is old news that parents and children have been experiencing an increased sense of uncertainty and vulnerability due to COVID-19. That vulnerability may be exacerbated by the news of violent protests that were sparked by anger over police brutality against black men and women. News of widespread violence around the country spread rapidly in a country already stressed to its capacity in dealing with a global pandemic and the resulting economic hardship. In the aftermath of these recent tragedies, parents should be aware that children may be experiencing collateral consequences, such as fear, anxiety and confusion. Rhea Boyd, MD, MPH, stated, “Whether from social media accounts, conversations with peers or caregivers, overheard conversations, or the distress they witness in the faces of those they love, children know what is going on. And without the guidance and validation of their caregivers, they may be navigating their feelings alone.” So, what do we do?

First, take care of yourself. Now is a good time to practice self-compassion and selfcare. The stress of watching traumatic events on television and smartphones “lingers within our bodies and minds,” states developmental pediatrician Dr. Jenny Radesky. Recognize that vicarious trauma is real, and even if you have not been directly affected, you may be experiencing heightened anxiety, difficulty sleeping, fatigue or increased irritability. Practice accepting your own feelings, instead of controlling them. Go for a walk, talk with a friend, practice relaxation techniques or do something you enjoy.

It is important to consider how we talk with children. While children from birth to age three do not understand what is happening, they can feel it through the reactions of the adults around them. You may notice that your young child has become more irritable, or perhaps crying more than usual. In addition to calming your child, limit the amount of time you spend accessing unsettling news reports in the presence of young children.

With elementary children, it is wise to begin your discussion with, “tell me what you know.” By elementary age, children have a good idea about what is happening. Asking children what they know and following up with any questions they might have will help you to provide age appropriate information. It is important to keep channels of communication open, because as time passes it is likely more questions will arise. Children may want to know that they are safe and, if they ask, provide reassurance. With that being said, limit their exposure to media, be it on television, tablet or smartphone. If they are accessing media, be aware of what they are watching and learning. Answer questions as appropriate and, as with all ages, validate their feelings and assure them that whatever they are feeling, it is okay.

It is probable that teenage youth have seen the images and been involved in learning about the events that precipitated the violence that unfolded. They may even be getting involved in activism by posting and re-posting social media messages. Teenagers often process events by talking with their peers, and it can, at times, be difficult to engage them in conversation. Approach the topic with your teen from a position of curiosity. What do they know? How do they know it? How do they feel about it? It is also a good time for you and your teen to become more educated about the history of racism in our country and how it has been perpetuated through generations of people. A broader societal context of racism will help youth have a better understanding of the anger seen in the demonstrations. A documentary called “13th,” about the 13th amendment, takes an in-depth look at the prison system in the United States and how it mirrors the nation’s history of racial inequality. It is both educational and provides a starting point for having conversations about race with your teen. Additionally, as much as possible, be aware of your teen’s online activity. There is a lot of misinformation and inflammatory rhetoric on social media, and teens need guidance on how to be thoughtful and responsible consumers of all types of media.

Given that the recent unrest was sparked by anger over police brutality against black people, it is important take this opportunity to have these conversations with children about race and racism. By age four, children have begun to internalize cultural attitudes and values, thus, it is not too early to introduce your child to the concepts of race and inequality. Books that include multi-racial characters are a good way to introduce children to people of color in a positive light. Common Sense Media has a list of books appropriate for kids of all ages beginning in infancy, and the link is provided below.

Experts stress that parents also need to give their children the broader societal context of racism to try to explain the rage of protestors filling the streets of cities across the nation. Doing so helps build empathy and teach perspective-taking, shifting the focus from the child’s specific fears. Helping children to view events from different perspectives provides understanding and promotes empathy. When your child sees something on television, YouTube or social media, employ a sense of curiosity. Ask them what they saw, how they felt about what they saw, and have them think about and share how they think different people involved in the situation felt. Dr. Radesky suggests, “Instead of focusing on questions the child may have about concrete things, ask them questions like ‘How do you think those people were feeling? Do you know why they were angry? What do you do when you feel like something is unfair?’” We all have our different perspectives regarding racism and the complex history of race in our country. Providing space for children to ask questions, discuss their feelings and process the world around them will help them cope with the myriad emotions that may arise due to current events and the sense of helplessness and fear they may be experiencing.

 

Some helpful resources:

https://www.pbs.org/parents/authors/jenny-radesky-md

https://www.commonsensemedia.org/lists/books-with-characters-of-color

https://www.commonsensemedia.org/blog/black-history-movies-that-tackle-racism

https://www.commonsensemedia.org/lists/movies-that-inspire-kids-to-change-the-world

https://pediatrics.aappublications.org/content/144/2/e20191765

https://raisingequity.org/

 

About the Author

Dr. Cynthia Hess recently graduated from Rivier University with a PsyD in Counseling and School Psychology. Previously, she earned an M.A. from Antioch New England in Applied Psychology. She also worked as an elementary school counselor and school psychologist for 15 years before embarking on her doctorate. During her doctorate, she did her pre-doctoral internship with RIT in Rochester, N.Y. where she worked with youth ages 5-17 who had experienced complex developmental trauma. Dr. Hess’s first post-doctoral fellowship was with The Counseling Center of New England where she provided psychotherapy and family therapy to children ages 5-18, their families and young adults. She also trained part-time with a pediatric neuropsychologist conducting neuropsychological evaluations. Currently, Dr. Hess is a second-year post-doctoral fellow in pediatric neuropsychological assessment, working with NESCA Londonderry’s Dr. Angela Currie.

 

To schedule an appointment with one of NESCA’s expert neuropsychologists, please complete our online intake form. 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

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