Tag

Transition Services

Transition Assessment: How to Prepare for the Team Meeting

By | NESCA Notes 2022

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

Every child who receives special education services in the United States is entitled to transition services—a coordinated set of activities that will facilitate the student’s preparation for postsecondary education and/or training, competitive employment, independent living, and community participation.[1] In order to provide these services, an IEP team has to first conduct “age-appropriate transition assessment.”[2] I have written about transition assessment in previous blogs, including Transition Assessment: What is it anyway? How is it different from neuropsychological evaluation? and Vocational Assessment and Transition Planning.

A challenge for students and families who are participating in transition assessment for the first time, is knowing how to prepare for team meetings where transition planning and services will be discussed. When you attend a team meeting after an occupational therapy evaluation or academic evaluation, you know that you are going to be discussing what occupational therapy services or academic instruction your child may need as part of their IEP process. However, when a student has participated in transition assessment, the team will be discussing a whole variety of activities (e.g., regular and specialized instruction, related services, community experiences, linkage to adult human service agencies) that the student will need to participate in as the student is preparing for adulthood. Some transition assessment reports contain dozens of recommendations for comprehensive planning. Recommendations may include activities that you are used to discussing with your team, such as instruction and services for a current IEP period, but recommendations may also include other activities that should occur outside of school with support from a parent or community member or actions that may need to occur at a later date. To make the most of your team meeting, it is helpful to do a little bit of homework and preparation after you receive your transition assessment report.

As discussed in previous blogs, if the student is going to be part of the team meeting (which they should be), then the student should have the opportunity to discuss the assessment results with the evaluator or another trusted adult. If your school district conducted the transition assessment, ask when and how they are going to review the results with the student prior to the meeting. If you obtained an independent or private evaluation, ask if you can schedule a student feedback meeting with that evaluator prior to the student’s team meeting. Students need to be aware of the findings and the recommendations that are being made, and they need to be prepared to actively participate in discussion about the results. Whether a student supports or disagrees with recommendations from a transition assessment can have a large impact on changes that are made, or not made, to the IEP.

In addition to student preparation, all team members should be prepared to discuss the assessment recommendations in a planful and organized manner. As a parent, it is helpful to read each recommendation in the report and consider the following questions:

  • Is this a skill or activity that you can reasonably tackle at home this year or in coming years? Do you need any training or consultation to be able to support the student?
  • Is this a skill or activity that would be best supported by a community provider rather than a parent, family member, or school staff?
  • Is this a skill or piece of knowledge that the student must attain this academic year in order to make progress toward their long-term goals? Do they need specialized instruction or related services to learn the skills or gain this knowledge?
  • Is this a skill, piece of knowledge, or service that needs to be focused on at a later time, but documented somewhere so that the team does not forget the recommendation?

It can be helpful to put together an abbreviated list of the goals, objectives, or services that you know your child will need this school year based on the assessment. Alternatively, some families find it useful to create a table or grid to organize transition planning activities. Here is one possible presentation that a family might use to prepare for a team meeting.

 

  Parent Community Providers School/IEP
Education/Training ·   Tour three colleges

·   Attend summer program on college campus

·   Counseling on enrollment process for postsecondary educational programs with Pre-Employment Transition Service (Pre-ETS) provider ·   Update postsecondary goals

·   Instruction of Study Skills, including notetaking

·   Assistive technology consultation

·   Personal Finance course

·   Sexual Health Instruction

Employment ·   Create first student resume

·   Set up informational interview with family friend who works as an accountant

·   Self-advocacy counseling with Pre-ETS provider ·   Help student obtain work permit

·   Support student in applying for paid part-time work

Independent Living ·   Review family health history

·   Teach student to complete medical history paperwork

·   Prepare questions with student ahead of medical appointments

·   Assist student in opening checking account

·   Include student in home maintenance activities

·   Individual counseling

 

 

·   Instruction in tracking sleep hygiene, diet, and exercise activities

·   Assistive technology consultation for health habits

Community Engagement ·   Support student in learning to carry out personal shopping activities ·   Social skills group with insurance-based provider

·   Study for driver’s permit test with Transition to Adulthood Program (TAP) provider

·   Travel orientation with local public transit authority

·   Make referral to Vocational Rehabilitation (VR) service provider

·   Invite VR service provider to team meeting with parent & student consent

 

 

It is also helpful to consider how the information from the transition assessment can flow through the IEP document. Information learned about the student’s postsecondary goals (i.e., the student’s goals for their life after high school) must be documented in the IEP and used to guide IEP development. Portions of the assessment may also be included as key evaluation results and current performance data, may inform how the team considers various federal and state special factors such as the students need for assistive technology or more functional means of communication, may suggest linkages that are needed with state resources and adult human service agencies, and may inform other aspects of the IEP. It is important to think about each section of your child’s IEP and how the assessment results might impact the team’s discussion of that section.

Many schools and families are familiar with transition assessment services at NESCA but do not realize that our transition specialists will consult with students, parents, and teams to plan for transition assessments, review assessments that have been conducted by other clinicians, or support the team meeting process. For more information about transition planning, consultation, and assessment services at NESCA, visit our transition services page and our transition FAQs.

[1] https://sites.ed.gov/idea/regs/b/a/300.43

[2] https://sites.ed.gov/idea/regs/b/d/300.320/b

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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, call 617-658-9800 or complete our online Intake Form.

Transition Planning: The Important Difference Between Postsecondary Goals and Annual Goals

By | NESCA Notes 2022

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

One of the most important aspects of transition planning for students with individual education programs (IEPs)—and for every student—is development of postsecondary goals. These goals are often described synonymously as the student’s postsecondary vision: the outcomes that the student and their IEP team expects the student to achieve after exiting public education. Legally, every IEP in the country needs to include explicit postsecondary goals in the areas of education or training, employment, and independent living, when appropriate. In Massachusetts, students need to have goals for Independent Living as well as Community Engagement. Because this topic is so important, I previously wrote a blog describing the importance of measurable postsecondary goals including a formula for writing such goals.

But, two years later, I am still finding that this is a misunderstood aspect of the IEP process, particularly here in Massachusetts. This is in some ways because our state IEP was not designed with transition planning or student-centered planning at the foundation. Currently, when you read an IEP from Massachusetts, there is only one section of the IEP used for describing the Vision Statement for the student. For students under the age of 14, this section is typically used to describe what the parents and team hope and dream for the student over the next 1-to-5-year period. But then, no later than when the student turns 14, we use the same section of the IEP to write out the student’s vision statement for after high school, and that statement legally needs to reflect the student’s preferences and interests and the student’s desired outcomes (i.e., postsecondary goals) for adult independent living and community engagement, work, and learning or training environments. For reference, this is the language currently in the Massachusetts IEP.

This shift is confusing! Parents are used to coming to IEP meetings ready to share their visions for their children, and students are often unprepared to share their goals for life after high school. But this shift is also absolutely critical for ensuring that students receive appropriate transition services. This is because every student on an IEP is legally entitled to participate in a coordinated set of activities that promotes their movement toward their postsecondary goals (i.e., their vision). These activities can include instruction, related services, community experiences, development of employment and post-school living objectives, and acquisition of daily living skills and functional vocational evaluation.[1] The only way a student can receive appropriate transition services, and an appropriately calibrated and coordinated set of transition activities, is if we clearly identify and define appropriate postsecondary (i.e., post-high school) goals for the student. And, these need to be listed out at the start of the IEP. In Massachusetts, these need to be listed in the vision statement.

Nevertheless, once we have done the important work of defining the student’s postsecondary goals or vision (which always involves transition assessment), then we have more important work to do. We have to make sure that the IEP that is developed includes necessary annual IEP goals, and related services, that will effectively support the student in making progress toward their postsecondary goals. We need to carefully crosswalk between each of the postsecondary goals set for the student and the annual goals we are developing. It is vital to make sure that there is at least one annual goal (or objective/benchmark within an annual goal) that addresses each of the student’s measurable postsecondary goals. We are very good at making sure that each of the services a student receives relates to the annual goals a student is working on. But we rarely pay attention to whether each of the student’s measurable postsecondary goals (i.e., each of the goals listed in the student’s vision statements) is supported by an annual goal. Annual goals for transition-aged students need to be determined from two sources: the student’s disability-related needs AND the student’s measurable postsecondary goals. Annual goals and coursework for a student with autism and language-based issues should be different depending on whether the student intends to be an artist or a veterinarian technician. Goals should be different for a student who intends to be a licensed driver and a student who intends to use door-to-door van transportation. In all cases, the team needs to annually discuss what skills the student needs to build this year in order to be able to attain their postsecondary goals in the future. The team needs to make sure that each postsecondary goal that the student has is supported by the student’s annual goals. If this is not explicitly discussed at the team meeting, we are not effectively planning for the student—and we are not effectively supporting students in being able to plan for themselves.

For more information about postsecondary goals and annual IEP goals in Massachusetts, check out Technical Assistance Advisory SPED 2013-1: Postsecondary Goals and Annual IEP Goals in the Transition Planning Process from MA DESE: http://www.doe.mass.edu/sped/advisories/13_1ta.html

 

[1] https://sites.ed.gov/idea/regs/b/a/300.43

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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, call 617-658-9800 or complete our online Intake Form.

Anxiety-based Procrastination: Tips for Getting over the Hurdle

By | NESCA Notes 2022

By: Lyndsay Wood, OTD, OTR/L
NESCA Transition Specialist & Occupational Therapist

Despite our best efforts, procrastination happens. There are many reasons that you may be putting off that large paper, important phone call or those dishes that are stacking up. You may not have the motivation, you may be tired, you may have more fun plans, or maybe it makes you feel anxious. In fact, one of the top reasons people procrastinate is anxiety. Anxiety rates have increased since the start of the COVID pandemic in 2020, and tasks that previously felt easy can now be daunting to think about. It is important to both treat yourself with kindness AND build up your toolbox so that you can tackle the day ahead. Below is a list of nine tips on getting over the procrastination hurdle when anxiety is taking over.

  1. Five minute max – For this strategy, set a five-minute timer and start the activity you have been putting off. Tell yourself that you can stop the activity after five minutes. More than likely, once you start, you will be able to keep going, but you have the option to stop after just five minutes. This strategy helps with perfectionism and all-or-none thinking that can stop you from starting your tasks.
  2. Task breakdown – Big tasks can often feel overwhelming, so breaking your big project, chore, etc., into small steps can help you get going. Tell yourself you will complete step one today and move on to step two tomorrow.
  3. Seek help – Take a step back. Do you have the skills to complete this task? Is there someone you could ask for help if needed? Do not be afraid to seek the help of others to get started!
  4. Reduce the standard – Identify one task that you would be less likely to avoid if you make it easier. For example, have you been putting off exercise because you are worried about going to the gym? Start with a 10-minute walk and build up to a longer exercise period once you are ready. This method is especially helpful to combat an all-or-none mindset.
  5. Notice negative predictions – Be aware of your thoughts and how they can impact, or even control, your actions. Are you making a negative predication about the outcome? If so, it can be helpful to go through the following questions in your mind to reframe your thinking:
    1. What is the worst outcome?
    2. What is the best outcome?
    3. What is the most realistic outcome?
    4. What might I learn if I am willing to take a risk?
  6. Recognize your strengths and challenges – If you find initiating, planning or sequencing tasks difficult when compared to your other skills, don’t misattribute procrastination to laziness or poor motivation. Mislabeling yourself as lazy can lead to further procrastination and decrease self-confidence. You may instead decide to seek extra support or tools to develop your executive function skills.
  7. Visualize – Visualize the finished product AND the feeling associated with completing the task. It is easier to start a task if you feel like you have already succeeded at it.
  8. Accomplishment journal – Keep a running list of accomplishments (even small ones) and check back in to boost your self-confidence for the tasks ahead. It is much easier to start a task when you are in a positive head space and see that you are capable of meeting your goals.
  9. Treat yourself with small rewards – Sometimes a small reward can help you get over a big scary hump. Perhaps after scheduling all of the health care appointments you have been putting off, you sit down and watch the movie you have been wanting to see.

There is no perfect strategy that works for everyone in every situation, but add these strategies to your toolbox and test them out. See if you can find just one tool to help you in those moments when anxiety is impacting your ability to get moving. You’ve got this!

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, 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, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Ready for Summer?

By | NESCA Notes 2022

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

It may seem an odd time to start thinking about summer plans with so much snow on the ground, but spring is less than 45 days away, and summer will be here before we know it! NESCA offers various coaching and counseling services, from executive function and real-life skills coaching to transition counseling and career counseling for high school students and young adults who are looking for support in determining their next steps. This summer, NESCA will also be offering two transition programs from July 11th-August 11th. Each program will meet for two hours twice a week.

 

It can be challenging for many of our teens and young adults to fit transition skills into their school day schedule. Additionally, most students benefit and require repeated opportunities to build skill mastery and generalize the skills across settings. NESCA’s summer transition programs are designed to fulfill that need. Program participants will be guided through interactive and engaging lessons with 3-8 peers to develop a detailed postsecondary vision plan that incorporates all aspects of adult life (i.e., education/training; employment; independent living; social, recreation, and leisure; and community engagement).

 

The College Transition: How, When, and What to Prepare program focuses on connecting strengths and interests to college majors and potential post-college careers. This program is an excellent fit for high school students who plan to attend a 2-year or 4-year program immediately after finishing 12th grade.

 

The Postsecondary Options Leading to Adulthood program focuses on exploring various postsecondary options and is an ideal fit for students who plan to attend non-traditional college programing, post-12th grade transition programs, or are still exploring/undecided about their next steps.

For questions, more information, or to obtain the Intake Form for either of the Summer Transition Planning Programs, please contact:

Crystal Jean

cjean@nesca-newton.com

617-658-9818

About NESCA’s Summer Transition Planning Programs

NESCA’s Postsecondary Transition Specialist and Counselor Tabitha Monahan, MA, CAGS, CRC, will be leading both summer transition courses.

College Transition: How, When and What to Prepare

Who: Students who are considering going directly to a 2-year or 4-year college after leaving public education

When: Mondays and Wednesdays from 2:00 to 4:00PM ET between July 11 and August 10, 2022

Where: NESCA’s offices @ 55 Chapel Street, Newton, MA

Participants Will:

    • Learn how to connect skills to college majors and potential post-college careers
    • Understand the differences between high school and college accommodations
    • Understand their current accommodations, explore those they use most and identify the most beneficial ones for success in college
    • Create a list of priorities when researching colleges; create a document to help conduct college research and when attending college tours

Postsecondary Options Leading to Adulthood


Who: Students who plan to attend non-traditional college programming, training programs, or receive employment/day service supports after leaving public education or are still exploring/undecided about their next steps after completing 12th grade

When: Tuesdays and Thursdays from 2:00 to 4:00PM ET between July 12 and August 11, 2022

Where: NESCA’s offices @ 55 Chapel Street, Newton, MA

Participants Will:

    • Explore postsecondary options other than college (i.e., MAICEI, Job Corps, certificate programs, MRC and DDS programs, other resources, etc.)
    • Work through strengths and challenges with more emphasis on general job skills and independent living skills
    • Learn about transferable skills and how skill-building at school, home, and in the community connects with success
    • Discuss resume development and learn about different resume formats
    • Understand why contacts are important
    • Learn about reasonable accommodations in the workplace and rights to request accommodations
    • Talk through how and when to disclose a diagnosis(es)

 

About the Author

Tabitha Monahan, M.A., CAGS, 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.

 

Meet NESCA Transition Specialist & Occupational Therapist Lyndsay Wood, OTD, OTR/L

By | NESCA Notes 2022

By: Jane Hauser
Director of Marketing & Outreach

NESCA is thrilled to have welcomed a new Occupational Therapist who is serving as a Transition Specialist on the Transition Services Team. Learn more about Lyndsay Wood, OTD, OTR/L, in my interview with her below.

How did you become interested in Occupational Therapy, specifically for transition-aged students?

Right after college, I worked in an assisted living center in an administrative role. I got to know the Occupational Therapist (OT) there, who was amazing at what she did. She helped people with the skills they needed to do on a daily basis. I asked to shadow her so I could learn more about the profession and what kind of skills she was teaching the residents to do. Energized by what I learned, I then became a Teaching Assistant (TA) in the CASE Collaborative’s high school program. This is where I started to learn about the needs of transition-aged students and how Occupational Therapy played a role in that area. Again, I was fortunate to learn so much from another talented OT, particularly around the importance of transition, with our students who are often underserved on that front. Moving into adulthood is so challenging, and it’s even harder when coupled with a disability. I found that the environments these students encountered every day just aren’t set up for them to succeed. I was able to help them move into adulthood and practice skills they would need to achieve their goals within these environments.

What made you realize that you wanted to work as a Transition Specialist?

I had already developed a passion for working with transition-aged students in the school setting both during my time as a TA and as an occupational therapist at The League School of Greater Boston. I loved working with the students on life skills, emotional regulation, and executive functioning. I found that I most enjoyed working with the students on hands-on, real-life learning. It seemed to be the most important and most effective way that, as an OT, I could help young adults and teens become more self-determined and thrive. They were able to see what they were able to do, and that was exciting!

Why did you join NESCA?

I loved working with students, but I wanted the opportunity to work with transition-aged youth out in the community. It’s often really difficult for this group to generalize what they learn in the school setting to the experiences they face in the community or even at home. I wanted to help them do just that.

I was thrilled to learn that NESCA offers Transition and Coaching services since I didn’t know anything like that existed outside of an academic setting. I initially joined NESCA as an Occupational Therapist; Executive Function and Real-life Skills Coach on a per diem basis during the summer of 2021. I got to take the skills our teens and young adults learn in school and tailor them to be put into place in the community in a hands-on way. We’re able to teach clients skills like grocery shopping, using the subway or Uber to get to where they need to go, making a deposit at the bank and any other skills they may need to succeed in real life. Having recently moved into a full-time Occupational Therapist; Transition Specialist position here, I look forward to doing much more of these kinds of activities!

What is the most rewarding part of what you do?

The most rewarding aspect of what I do is when I actually get to see the client perform the skill(s) that they have had a hard time with and that they have been working toward for so long. Watching them accomplish their goal is so gratifying. When you see that success, it’s a wonderful feeling!

I also love that I am able to do what I do – not only within the walls of a classroom or school – but in the outside world. I always wanted my students to practice the skills that we were working on in the school environment out in the real world so I knew they would be prepared for experiences they were likely to face in their daily lives. This could be anything from placing an order at Starbucks, riding the bus or refilling a prescription. I get to do that with them here at NESCA…and so much more.

What’s your specialty area? Who do you most enjoy working with?

My passion is working with those who are on their way to adulthood. I am definitely where I want to be with the transition-aged youth and young adults! When working with teens, you get to see them prosper and make monumental changes that can help them build a high quality of life, allowing them to be successful and happy for a greater portion of their lifespan.

I really enjoy working with a wide population of clients, including those with mental health challenges, Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). I especially find it rewarding to work with young adults with mental health issues, such as anxiety or depression, to help manage those challenges and lead a fulfilling life.

Tell us a little about yourself. What do you like to do in your spare time?

I grew up in Acton, Massachusetts, and I’m a big outdoors person. I like to spend most weekends in Vermont or New Hampshire, exploring new places to hike. I also enjoy skiing, kayaking and most other outdoor activities. I also like to read, play weekly board games and dance when I get the chance!

 

About Lyndsay Wood, OTD, OTR/L

Lyndsay Wood, OTD, OTR/L, is an occupational therapist who focuses on helping students and young adults with disabilities to build meaningful skills in order to reach their goals. She has spent the majority of her career working in a private school for students with ASD. She has also spent some time working in an inpatient mental health setting. Lyndsay uses occupation-based interventions and strategies to develop life skills, executive functioning, and emotional regulation. While completely her doctoral degree at MGH Institute of Health Professions, Lyndsay worked with the Boston Center for Independent Living to evaluate transition age services. She uses the results from her research to deliver services in a way that is most beneficial for clients. Specifically, she focuses on hands-on, occupation-based learning that is tailored the client’s goals and interests.

 

To book coaching and transition services at NESCA, 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, as well as Londonderry, New Hampshire. NESCA serves clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

Ring in the New Year with SMART Goals

By | NESCA Notes 2022

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

Happy New Year! 2021 was another chaotic and challenging year. Many folks have big plans to start the year strong and make hefty goals for their new year resolutions. French writer, Antoine de Saint-Exupéry, wrote: “a goal without a plan is just a wish.” This is true for resolutions, just as it is for any goal. How can we help our young people change their wishes, visions, and dreams into goals? We teach them (and maybe ourselves while we’re at it) how to plan. One of my favorite strategies for both teaching and reaching goals is by creating SMART Goals. What is a Smart Goal?

Specific – The goal should be specific. I’ll increase the distance I run is vague. Will you increase the distance by 20 feet, 2 miles? Are you planning for a marathon? Instead, let’s take a look at step 2, making it measurable.

Measurable – There’s a good chance that if your goal is not specific enough, it will be hard to measure if you have succeeded in that goal. So, let’s make our exercise goal both specific and measurable. I’ll increase the distance I run from 1mile to 3.2 miles (5k).

Attainable – Attainable is the hard one for many students who are still building awareness of their strengths and challenges. Let’s say a person who has never run wants to run in the Boston Marathon. This is likely not an attainable goal, even if it is specific and measurable. While Couch to 5k training exists, I have not personally seen the couch to marathon training program. Having measurable steps also helps break down the goal into smaller pieces, which will be further discussed later.

Relevant – If I am trying to increase my social circle and group leisure skills, running is unlikely to get me there. However, if, like many people, we’re trying to improve our health in 2021 (or take off some of those quarantine pounds), increasing the distance we run certainly will help get us there. Many young adults may need to bounce ideas off someone to ensure the goal is relevant to the area at hand.

Time-bound – Attainable and time-based work tightly together. If you do not give yourself a deadline, the goal may still be there come December 2022. Humans work best with deadlines. We need the motivation to complete a plan, and often motivation needs a sense of urgency.

When students begin working on developing SMART goals, the hardest area for students to understand and develop is creating an ATTAINABLE goal. The goals are often too hefty and need to be broken into much smaller pieces. My clients who are meeting with me in person are greeted by a quote in my office from Dr. Glenn Doyle, offering my favorite way of looking at creating that attainable goal.

When in doubt, set the goal small.

Then chop it in half (½)

Then take the first part of that goal….

Figure out just what you’d need to do

to GET STARTED on it.

THAT’s your NEW GOAL.

~Dr. Glenn Doyle~

(emphasis mine)

Okay, so what does our SMART goal look like for increased health and wellness? I will increase the distance I run from 1 mile to 3.2 miles (5k) in ¼ mile increments by June 30, 2022.

We have all the pieces. It is specific, and we know precisely what the end goal will be and how we will get there. It’s measurable; there is something we can check off as complete, like a to-do list. It’s attainable and seems realistic. We are not trying to run the Boston Marathon course after only running a mile. We will start as a beginning runner and work towards a 5k, and we are not trying to do it tomorrow with no steps in between. It’s relevant; we are working on bettering our health in 2022. And it is time-based. We want to meet our goal by the end of June.

Now that we’ve refreshed our minds on SMART goals, how do we build these skills in transition-aged youth? Ask them. Ask your child, your students, your clients what they want for themselves in education, employment, and independent living. We already have the starting points. We have their vision. We have the IEP TEAM’s goals and objectives.

The youth may have a far-reaching (and maybe seemingly unattainable) goal. Help them break that big goal down into smaller parts and work backward. Do they want to be an engineer? Engineers need a college degree. What does the student need to do to graduate college? They need to get into college. How do they get into college? They need to apply and graduate from high school. What do they need to do to graduate high school? They need to pass their science class. That seems like a reasonable starting place, and it is still related to the vision. What might a SMART goal look like for that student? I will receive a passing grade on my final exam by answering the end of chapter questions each week and asking for clarification from my teacher for any questions I got wrong by the end of the spring semester.

But how do we support them when they aren’t making progress? Many people have a hard time adjusting once they have made a plan. Whenever we set a goal, we need to look at our progress periodically. We need to check that the goal is still attainable by the deadline we gave ourselves. Are we making progress? If we are still running only a mile and it’s March, what adjustments do we need to make? Suppose a student is not finding answering the end of chapter questions helpful in confirming their knowledge of the material. What changes can they make to increase their understanding of the material? Maybe the student asks the teacher if they can work one on one twice a week to increase understanding? Frustration, when the plan doesn’t work, makes many give up on the goal. Learning how to adapt is just as essential as learning how to make a goal.

A person who has practiced SMART goals is a person who will have an increased understanding of the objectives and smaller steps they need to reach their vision. They will have more confidence in their abilities and more awareness of their challenges. A person who has goal-setting skills is a person who has control of their own life. What are your SMART goals for 2022?

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.

 

Assessing Work Motivation and Values

By | NESCA Notes 2021

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

Over the past few months, my colleague Tabitha Monahan and I have dedicated several of our blog entries to vocational assessment as a critical tool for helping students learn about employment and set career goals for themselves. Previous blogs have provided an overview of vocational assessment as well as an in depth look at career interest inventories, vocational aptitude testing, and real-life experiences, such as informational interviews and job shadows. However, there is another type of vocational assessment that we have not yet discussed that can be an invaluable tool for helping students to learn about their “vocational selves” and ultimately choosing occupations that are a good fit—a work motivation or work value assessment.

Work motivations or values are the qualities, principles, or standards that really matter to a person as a worker. Essentially, if you are going to get out of bed every day and go to a job, what are the characteristics that your job needs to have in order for you to feel that going to work is worthwhile? Certainly, money can be an important characteristic of a job, but is that more important to you than helping others, creativity, or recognition? Each of us has a different set of values that will drive us to make choices and take action in our lives, and having an occupation that satisfies those values is just as important as having a job that aligns with our interests and skills.

Similar to career interest inventories, work motivation and value assessments come in many shapes and sizes, some formal (e.g., lengthy and standardized) and some informal (e.g., short checklists or rating scales). Also, similar to career interest inventories, it can be helpful to administer or self-administer more than one of these assessment tools to get a sense of how clear one’s work motivations and values are (i.e., how often an individual responds to assessments with a similar pattern of expressed values). Additionally, it is recommended that students not just take assessments, but that educators and career counselors engage students in qualitative conversations about their results so that students have the opportunity to clarify their values as well as more quantitative exercises, such as comparing work values with career interests.

While there are many different work motivation and value classification systems, I’m choosing to highlight the four work motive categories and eight value constructs from one of my favorite assessment tools, the Work Motivation Scale below.

Fulfillment Motives: The need for work that provides the individual with opportunities to reach their maximum potential. Creativity, curiosity, foresight, and competence are attributes that are often observed in individuals with high fulfillment motives. Fulfillment motives are comprised of the following work value constructs:

  • Success Orientation: Individuals scoring high on this construct are motivated toward accomplishing career goals and reaching their full potential through their work. Passionate about their work, they are willing to endure periods of hardship to be successful.
  • Mission Orientation: Individuals scoring high on this construct are oriented toward seeing the big picture and tend to be less concerned with details. Goal directed, they recognize how their current work fits into and contributes to the overall direction of the organization.

Self-Esteem Motives: The need for achievement, responsibility, and challenging and meaningful work tasks. Links between leadership and achievement are usually present for individuals with high self-esteem motives. Self-esteem motives are comprised of the following work value constructs:

  • Managing Others: Individuals scoring high on this construct value opportunities to direct and supervise the work of others. They willingly take responsibility for worker  performance and the productivity of a work unit, department, or work function.
  • Task Orientation: Individuals scoring high on this construct are oriented toward completing tasks. Planning their work, making the most of resources, and maintaining their focus are important to them. They may hesitate to perform functions outside of those tied to a specific job description.

Affiliation Motives: The need for the acceptance and support of coworkers and supervisors. Cooperation and collaboration toward meeting work goals are sought by individuals with high affiliation motives. Affiliation motives are comprised of the following work value constructs:

  • Supervisor Relations: Individuals scoring high on this construct feel that cooperating with and relating to their supervisor are important. They strive to meet their supervisor’s expectations and highly appreciate their supervisor’s recognition and support.
  • Coworker Relations: Individuals scoring high on this construct feel that relating to peers is important. They prefer to be actively involved in employee related organizations at work and outside of work. They highly value collaboration and teamwork.

Survival and Safety Motives: The need for employment with an adequate livable wage and a safe and secure work environment. The need for favorable benefits packages is also valued by individuals with high survival and safety motives. Survival and safety motives are comprised of the following work value constructs:

  • Working Conditions: Individuals scoring high on this construct believe that a good work environment and creature comforts (climate control, privacy, adequate lighting) are important. They value having the materials, equipment, and resources to do their work effectively and efficiently.
  • Earnings and Benefits: Individuals scoring high on this construct value salary, raises, health insurance plans, pensions, and retirement planning. Vacation, sick leave, personal days, and family leave policy are important considerations in their employment choices as well.

Definitions provided by/taken from the Work Motivation Scale Administrator’s Guide.

Understanding which of these constructs and categories matter most to a student, and a student understanding this about themselves, can have a huge impact on helping a young person to find fulfilling work.

To read more about vocational assessment, check out the following blog entries:

For more information about vocation assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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, call 617-658-9800 or complete our online Intake Form.

Building Skills over the Holidays

By | NESCA Notes 2021

By: Becki Lauzon, M.A., CRC
Transition Specialist and Consultant

The holidays tend to come with more time off for students and families wondering what they can do to keep up with skills and activities. On the plus side, the holidays also lend themselves to activities that typically don’t occur year-round. Below are some helpful suggestions for students and their families to fight boredom and work on building skills:

Learning about different cultures and traditions

Giving back to the community

  • Building a sense of community has always been a big part of transition work with my students. Many communities offer opportunities to give back during the holiday season, such as giving gifts to those who are less fortunate, helping out at a food pantry, serving meals, etc. Using the internet to search for opportunities within your community can be very rewarding during this time of year.

Seasonal work

  • Many places are hiring seasonal employees this time of year. For individuals who are unsure of making a long-term commitment to a job or want to sample something, this can be the perfect time of year for that!

Plan and prepare a meal

Giving gifts

  • If your child needs to purchase gifts for friends or family members, this can be a great opportunity to turn it into a learning opportunity. Start by having them identify the person they are buying for and a few things that the person likes. Next, give your child a budget for the gift and spend some time searching online to identify items they may want to purchase. By preparing in advance, it allows for an easier shopping experience in the store!

Holiday cards/thank you notes

 

About the Author

Becki Lauzon, M.A., CRC, works with teens, young adults and their families out of the Newton, MA and Plainville, MA offices. Lauzon has unparalleled experience as a Transition Specialist, Transition Consultant and Vocational Program Coordinator. Lauzon will be providing transition assessment (including testing, functional evaluations and observations) consultation, case management, training and professional development for schools; and transition planning, consultation and coaching for transition-aged students and their parents.

 

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.

 

Career Counseling at NESCA

By | NESCA Notes 2021

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

Career Counseling is a fluid process that typically occurs throughout a person’s lifetime. It begins when children are young and learning about different jobs that their family members have and what they see on television. As children get older, more pieces get added to that initial exploration.

What does Career Counseling through NESCA look like? It can be broken down into three distinct categories. Still, students and young adults frequently jump back and forth between the categories several times throughout the process. Today’s blog focuses on discussing these categories in a little more detail.

Who am I?

Each case begins with an initial interview with the client to learn more about them, their interests, goals for the future, and goals they wish to achieve in counseling. Often formal assessment measures are given to discover the client’s areas of interest and aptitude. We will then explore those results and connect them to their stated goal. Sometimes the results align well with the person’s initially stated goal; frequently, this is an eye-opening experience. Depending on the client’s needs and goals, additional formal and informal exploration activities will be completed to allow the client to build further understanding about who they are as a learner, worker, and what motivates them.

Exploration

Career Counseling at NESCA is a data-driven process. Whether the data is from formal or informal measures, the client is guided through and assisted in understanding who they are and how that can connect to a happy and successful career. At this stage, clients will be assisted in exploring careers of interest that they have identified and learn about the careers in more detail, such as learning education requirements, typical job tasks, and how their strengths and areas of challenge will affect their potential success in the identified jobs. Additional skills worked on will include writing resumes and cover letters, interview preparation, and identifying possible reasonable accommodations and disclosure. If appropriate, informational interviews and job shadowing opportunities will be explored.

Moving forward

Once a client has learned the type of work they would like and understands foundational work skills, the next step they will take with the career counselor is to start the job search. In a systematic fashion, clients will be supported in finding available openings, applying for specific jobs, customizing cover letters and resumes for individual jobs, and pre-interview preparation. Additionally, goal setting, time and task management, and other employment success skills are explored during this process.

Continued success

Once a client has successfully been hired for a position, many continue their work with a career counselor. Typically, sessions decrease after a person becomes employed, but it is recommended that follow-up meetings occur at 1-week, 1-month, and 3-months post-employment to check in and problem solve any areas of concern that arise. Clients are encouraged to reach out before these times if an issue occurs to assist in finding a solution before the problem affects their employment.

Who is a good fit for Career Counseling at NESCA?

  • High school students who are not sure of what they want to do after high school and have a hard time developing their vision for their future (whether in creating their IEP vision or in general).
  • High school or college students who do not know what major to pick as they do not know the type of work they want to do after college.
  • Recent college graduates who need support in their job search and interview preparation.
  • Young adults who are looking to figure out their next employment steps or have had difficulty remaining employed once hired.

While the above is a general idea of what a Career Counseling client can expect, each person’s journey through the process is unique. For an in-depth conversation on how Career Counseling at NESCA may support you or your child in meeting their career goals, please fill out our intake form or call our main office at 617.658.9800. Services are currently being offered remotely, with limited in-person services starting this fall.

 

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.

 

Vocational Aptitude Testing

By | NESCA Notes 2021

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

Over the past month, my colleague Tabitha Monahan and I have been dedicating our blog entries to vocational assessment as a critical tool for helping students learn about employment and set career goals for themselves. Previous blogs have provided an overview of vocational assessment as well as an in depth look at career interest inventories and real-life experiences, such as informational interviews and job shadows. Many of these tools provide opportunities for students to learn more about the world of work and types of jobs that match with their interests and things that they know they like. Today, I am going to share information about a different type of assessment, vocational aptitude testing.

It is not uncommon for middle and high school students to have job aspirations that do not fully align with their physical and cognitive strengths or even their general preferences for daily work (e.g., being seated, indoors, casually dressed, etc.). When you have had very little exposure to employment and you spend most of your time in a structured educational environment, it is hard to picture yourself as a worker and fully appreciate the skills, knowledge, education, abilities, and experience needed for a particular job. Vocational aptitude testing is formal testing of a set of abilities known to impact an individual’s potential for success and satisfaction in a variety of occupations.

Similar to intelligence or cognitive assessment tools, vocational aptitude tests vary in format, activities, and the defined abilities or factors that are tested. For instance, at NESCA three of the most common vocational aptitude tests we use are quite different from one another—an online computer-based assessment tool that is designed for self-administration, a paper-based assessment tool that is formally administered in an office or classroom with both a test booklet and scantron answer sheets, and a functional hands-on set of performance activities that simulate actual work activities (e.g., sorting mail by zip code, alphabetizing post cards, assembling pipes, tightening screws, etc.). However, most vocational aptitude tests include tests designed to evaluate the following aptitude factors (i.e., abilities):

Verbal Aptitude – The ability to understand and use words effectively, to comprehend verbal concepts and language, and to express ideas clearly in words. People who score highly generally do well in school, particularly in subjects where verbal concepts are important.

Numerical Aptitude – The ability to do arithmetic and other numerical computations quickly and accurately. People who score highly on this aptitude may do well in such school subjects as math and physics.

Spatial Aptitude – The ability to visualize two-dimensional objects in three-dimensional space, and to mentally manipulate objects through different spatial orientations. People who get high scores have the aptitude to perform well in school subjects and work involving drafting, art, architecture, clothes designing, and so on.

Perceptual Aptitude – The ability to compare and discriminate words, numbers, symbols, or other graphic material to see if slight differences exist between them. People who score highly in this area should do well in proofreading, copyediting, and nonverbal tasks that require attention to detail and rapid visual discriminations.

Manual Dexterity – The ability to coordinate eye and hand movements and perform manual tasks rapidly and accurately. High scores indicate the ability to manipulate tools and objects with speed and precision.

General Ability – The ability to learn and achieve in training or academic situations. People who get high scores “catch on” quickly in new situations, and are proficient in making judgments and in grasping underlying principles and solving problems. (This is often computed through summing or averaging an individual’s verbal and numerical aptitudes.)

Definitions provided by/taken from the Occupational Aptitude Survey and Interest Schedule Aptitude Survey (OASIS-3: AS) Examiner’s Manual.

If a student has participated in other kinds of standardized testing over time, especially intelligence testing and occupational therapy testing, it is likely that quite a bit of information is already known regarding the students’ aptitudes for employment. However, there are many vocational aptitude tests that are bundled with interest inventory tests, enabling a quick and clear comparison of the student’s vocational aptitudes and interests. For example, the OASIS-3 Aptitude Survey mentioned above is part of a testing kit that includes the OASIS-3 Interest Schedule and an Interpretation Workbook for easily comparing jobs within a student’s interest areas with their current career abilities.

Career aptitude testing can give a student a clear sense of their relative strengths and areas of challenge as well as a sense of how their current abilities compare with the abilities required for jobs of interest. However, it is important to caution that career aptitude testing does not predict the kind of work that a student should do. Results of career aptitude testing may differ considerably based on many factors, including new learning and work experiences. Results of testing should change as a student gains education and work exposure and can certainly be used to help us understand what skills might need remediation for a student to have a better chance of participating in certain kinds of employment.

One final thought regarding career aptitude testing is that while it can sometimes be an option to administer standardized testing with accommodations, I would encourage only providing accommodations that would reasonably be provided on a work site. For example, offering a student who has comprehension or processing speed difficulties the opportunity to take aptitude testing with unlimited time may not help the student to get a sense of how their aptitudes truly match up with the demands of a particular job. The reality is that most employers are not able to give employees unlimited time to do their jobs. Using text-to-speech during computer-based administration of a test may be far more relevant as long as test results are interpreted with the need for this accommodation in mind.

To read more about vocational assessment, check out the following blog entries:

For more information about vocation assessment and transition assessment at NESCA, visit our transition services page and our transition FAQs.

 

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. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. 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, call 617-658-9800 or complete our online Intake Form.