A growth spurt for TRIAD

mother playing with young son

VKC TRIAD enhanced and widened the reach of its programming in 2015 and shows no sign of slowing in 2016. From partnerships with the TN Department of Education to the design of innovative telemedicine models of service delivery, TRIAD continues to make a profound impact on improving access to autism services in TN.

The addition of 18 new TRIAD personnel in 2015, including 13 practitioners (teachers, speech language pathologists, board certified behavior analysts, and psychologists); 4 research assistants; and 1 administrative assistant are indicative of TRIAD’s rapid growth. In an effort to illustrate this growth as well as the rich diversity and impact of TRIAD activities, highlights from staff and faculty program coordinators and investigators are included below.

School-Age Training Program

Sarah Blumberg, Ed.D., BCBA-D, TRIAD Elementary and Middle School Program Coordinator

TRIAD’s School-Age Program was awarded a 5-year, $10 million technical assistance grant from the Tennessee Department of Education to continue its efforts to train and support educators across Tennessee. This will include over 75 unique professional development opportunities per year. Additionally, collaborations with VKC investigators are resulting in the development of tools and strategies to best evaluate and to conduct research on the effectiveness of programming.

Telemedicine integration to increase service delivery

Alacia Stainbrook, Ph.D, TRIAD Early Intervention Program Coordinator

Over the past year, TRIAD has worked to identify and to design telemedicine models of service delivery to increase access to services for families and school personnel. Telemedicine, which allows for remote diagnosis and treatment of patients by means of telecommunications technology, has been introduced across multiple fields to care for patients unable to readily access providers. Recently, behavioral assessments as well as caregiver and provider trainings for treating individuals with intellectual and developmental disabilities have been conducted via telemedicine.

TRIAD’s Evaluation Support Team uses a telemedicine model to provide education and to support early intervention providers who serve families of young children with autism spectrum disorder (ASD). Currently, TRIAD is providing these services to providers in the Bedford County area. Families and providers work together in a space provided by the Bedford County Community Center. TRIAD consultants use designated video conferencing systems and Bluetooth technology to observe and to provide live feedback and support to the providers.

This telemedicine technology also is being used to provide student-specific assessment and consultation to school personnel in some rural counties of Middle Tennessee. The telemedicine model allows consultants to do live observation and data collection on students and classrooms without leaving Vanderbilt. The cost-effectiveness of this model allows for more frequent observation, data collection, and feedback across both projects.

Early Learning Program

TRIAD has developed an Early Learning Program, which is led by Dr. Alacia Stainbrook. This new program combines TRIAD’s existing early intervention and early childhood school programs, and places a specific emphasis on transitions to and from preschool.

Early Intervention expansion

Alacia Stainbrook, Ph.D, TRIAD Early Intervention Program Coordinator

TRIAD’s Evaluation Support Team addresses the increasing need for early behavioral intervention services in Tennessee. Since March 2014, TRIAD has provided caregiver support and education services to more than 150 families of children recently evaluated for ASD. The team also has provided collaborative and consultative services to approximately 40 community-based early interventionists who serve families of young children with ASD.

A primary focus in 2016 is to reach more families in rural areas, who often have limited access to services. As part of this expansion, TRIAD plans to increase the use of telemedicine models of evaluation and service delivery in order to provide more intensive services to families and interventionists in rural areas who cannot readily access additional support and education services. Additional goals include increasing service access for Spanish-speaking families and extending services across West Tennessee.

Early Childhood Program

LaTamara Jackson Garrett, M.Ed., BCBA, TRIAD Early Childhood Program Coordinator
Ali Spidalieri, TRIAD Educational Consultant

TRIAD’s Early Childhood team, with support from a grant through the Tennessee Department of Education, has established three model classroom sites across the state. To have the greatest reach, a model inclusive pre-kindergarten classroom was established in each of Tennessee’s three Grand Regions. TRIAD provided coaching and mentoring to inclusive classrooms in Putnam, Gibson, and Cocke counties. Coaching and training focused on embedding evidence-based practices into daily classroom routines. Each participant received a follow-up site visit from their TRIAD consultant. TRIAD has trained 60 early childhood educators in the use of evidence-based practices for students with ASD and related disabilities.

Community Engagement Program

Lauren Weaver, M.S., BCBA, TRIAD Organizational Outreach Coordinator

TRIAD’s Community Engagement Program works to increase awareness, acceptance, and accessibility in the community for children with ASD and their families. TRIAD has collaborated with 11 community partners including Cheekwood Botanical Gardens and Museum of Art, Country Music Hall of Fame and Museum, Frist Center for the Visual Arts, Nashville Children’s Theater, Nashville Opera, Nashville Predators, Nashville Public Library, Nashville Zoo at Grassmere, Tennessee Performing Arts Center, Vanderbilt Athletics, and the YMCA of Middle Tennessee.

Since the program’s inception in 2013, TRIAD educators have provided training to 312 staff and volunteers for a total of over 736 professional development hours, developed 32 general evidence-based supports for families to use when attending one of the community organizations, and collaborated on 30 events with over 4,000 people in attendance.

With support from a grant award from the Department of VSA and Accessibility at the John F. Kennedy Center for the Performing Arts through the Nashville Opera and another through Jackson, the program’s reach is expected to increase for the 2015-2016 inclusive events to over 60,000 people, thanks to TRIAD’s expansion work with the Nashville Opera and the Nashville Predators. The program also is partnering with the Metro Nashville Police Department to pilot an educational event and resource for the officers at the Midtown Precinct. The impact of this work has the potential to reach thousands of individuals.

Families First Workshops

Whitney Loring, Psy.D., TRIAD Families First Program Coordinator

TRIAD’s Families First continues to provide free monthly workshops for parents of young children newly diagnosed with an ASD. The primary goal of Families First is to equip parents and caregivers with hands-on, practical tools to support their child at home and in the community based on the principles of Applied Behavior Analysis (ABA).

Families First is a place for families to start to set goals and to apply strategies related to the topics presented. The information is provided in a structure where parents and caregivers have an opportunity to meet other parents of children with ASD with similar questions or concerns.

In the past year, topics included addressing challenging behaviors; beginning toilet training; teaching safety skills; promoting community inclusion; developing social, play, and communication skills; and a new topic focused on supporting successful medical visits, procedures, and daily practices.

In 2015, Families First had 292 attendees across 9 workshops. The program was able to serve 124 children in child care free of charge to families, along with providing handouts, visual supports, and other materials to aid in implementing the strategies discussed once they leave. The team of consultants and postdoctoral fellows who support this effort has been expanded. Efforts are now focused on integrating research questions regarding the implementation of the strategies discussed during the workshops.

Mindfulness for educators

Sarah Blumberg, Ed.D., BCBA-D, TRIAD Elementary and Middle School Program Coordinator

Teacher “burnout” is higher in the field of special education than in general education classrooms. To address this issue, TRIAD’s Professional Development and Training Team has created useful tools for educators across Tennessee that highlight the role that mindfulness, an evidence-based practice for stress reduction, can play in education. Exciting outcomes show that incorporating this practice into everyday activities has benefits not only on an educator’s well-being, but also on that of their students.

To accomplish this training, the team created an eight-session Basic Online Training Session (BOTS) series that educators may watch at their convenience. Through this online resource, as well as in live presentations, TRIAD’s goal is to acknowledge the demands and stresses on educators, to introduce and to define mindfulness and its benefits, and to provide simple, short mindfulness exercises that can be implemented in day-to-day life.

Ongoing research on parent stress

Amy Weitlauf, Ph.D., Assistant Professor of Pediatrics

As part of a grant funded by the Maternal and Child Health Bureau, a TRIAD team of behavioral and psychological professionals is studying interventions targeting parenting stress and ASD symptoms in 18- to 36-month-old children. The approach is based on the research of Elisabeth Dykens, Ph.D., Annette Schaffer Eskind Chair, professor of Psychology, Psychiatry, and Pediatrics, VKC director and UCEDD co-director.

The ongoing randomized controlled trial compares two groups of participants. In one group, parents receive individual training in Mindfulness-Based Stress Reduction (MBSR) as well as an intervention with their child that is based on the Early Start Denver Model (P-ESDM). In the other group, participants receive P-ESDM only. This project then tracks families for 6 months post-treatment, assessing factors such as child symptomatology, parental health, and family functioning. Its goal is to determine if directly treating parent stress augments child-focused interventions and improves outcomes across the family system.

Ongoing collaboration with Robotics and Autonomous Systems Lab

Amy Swanson, M.A. TRIAD STAT Project Manager

TRIAD’s collaboration with the Robotics and Autonomous Systems Lab in the School of Engineering at Vanderbilt closed a highly productive 2015. The partnership is continuing in 2016 with several new projects underway. After successful pilot projects examining three distinct collaborative virtual environments with over 50 children and adolescents with autism, the team has completed development of applications of the interactive tasks suitable for mobile devices, allowing for use beyond the laboratory and into homes and schools.

Development and pilot testing of a non-invasive robotic intervention platform integrated with an intelligent environment specifically designed to accelerate improvements in early joint attention skills and imitation skills was realized in 2015. This work will continue with a controlled clinical trial examining improved response to joint attention with toddlers. Through consultation with Carissa Cascio, Ph.D., assistant professor of Psychiatry, and the expert mechanical engineering oversight of Nilanjan Sarkar, Ph.D., professor of Mechanical and Computer Engineering, the lab is in the final stages of developing a mechanism to apply and to evaluate affective touch and sensory patterns with infants at elevated risk for autism.

Improving Hospitalization for Children with ASD

John Staubitz, M.Ed., BCBA, TRIAD Coordinator of Behavior Consultation

TRIAD was awarded funding through the Autism Speaks Autism Treatment Network’s Autism Intervention Research Network on Physical Health (AIR-P) to conduct a pilot study aimed at improving outcomes for children and adolescents diagnosed with ASD who were receiving inpatient treatment related to behavioral concerns. A team of Board Certified Behavior Analysts (BCBAs) assisted by the faculty and students of Vanderbilt University’s Special Education/Behavior Analysis graduate program trained hospital staff at Vanderbilt University Medical Center, conducted rapid assessments, and provided treatment and staff support throughout the course of the six-month study. In total, 36 families participated and were randomly assigned to either a treatment or control group during their hospitalization at the Vanderbilt Children’s Hospital or Vanderbilt Psychiatric Hospital.

The team of researchers from TRIAD are analyzing the costs and benefits of supplementing traditional care with Applied Behavior Analytic (ABA) assessment and treatment. Patients were able to participate in assessments on their hospital units that were quick and safe, allowing TRIAD’s BCBAs to determine the function of the patient’s challenging behavior and develop an individualized plan for addressing behavioral concerns. Preliminary results from this study were presented at the annual conference of the Tennessee Association for Behavior Analysis and the Association for Behavior Analysis International’s annual international conference in Kyoto, Japan. Study investigators include TRIAD medical director Kevin Sanders, M.D., TRIAD executive director Zachary Warren, Ph.D., and TRIAD director Pablo Juarez, M.Ed., BCBA.

For more information on these and additional TRIAD activities, visit vkc.mc.vanderbilt.edu/VKC/triad.

Courtney Taylor is VKC associate director of Communications and Dissemination.

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