Archive for February 2016

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Mindful Monday- A Higher Sense of Self

mindfulA Higher Sense of Self

In a year of Living with more Compassion, Michael Yapko, PhD uses the term,” a higher sense of self” to refer to the small but important gestures we make when showing compassion for self and others. This might be getting up a few minutes earlier to make a lunch for your spouse, taking the time from your busy day to acknowledge a friend or colleague, or  “catching yourself” when upset with someone before saying something unkind. All of these are demonstrations of a higher sense of self.


Write down examples of the small gestures you’ve extended to yourself or others this week. Note your feelings. For example, you might have felt upset with someone but later proud that you refrained from saying something unkind. Or you may have felt stressed about being able to do something nice for your spouse but after getting up earlier and still getting to work on time, glad that you made the effort. Another exercise is to pay attention to the gestures of others and if appropriate, let them know your observation.

Quote of the week

 “If you can talk, you can sing. If you can walk, you can dance.”    ~Tribal Saying, Zimbabwe

Ask Dr. Emily-Staying up too late?

Welcome to the February edition of Ask Dr. Emily! We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights here, on the last Friday of each month, in a question and answer format. We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to

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Autism and Washington State Insurance Updates

Insurance iconAutism & Washington State Insurance Updates

With the roll-out of the Affordable Care Act, health care coverage has become even more complicated that it was before – and it was really complicated before! Although more children and families have access to health care coverage, there remain barriers in the system – particularly due to some plans with limited networks. Kathy Brewer, MS, LMHC, Psychiatry Insurance Processing Manager at Seattle Children’s shares valuable updates about Washington State insurance changes.

What are some of the changes?

  • Federal parity laws were implemented that require most (but not all) plans to cover mental health services at the same level as medical. This means the copay, co-insurance and deductibles are the same. This doesn’t mean the network is the same. And some plans continue to put restrictions on covering specific psychiatric diagnoses.
  • Also in October of 2015, the United States switched to using ICD-10 which has updated medical and mental health diagnosis codes with more specificity. Most insurance plans have converted to accepting ICD-10 codes with few problems seen so far.
  • More commercial insurance and now Washington Medicaid is providing an Applied Behavior Analysis (ABA) benefit for children with Autism Spectrum Disorders. Although there are waitlists at most agencies, the number of agencies are increasing and the ABA benefit is allowing more children to receive this helpful service.

At the Seattle Children’s Autism Center, we continue to have medical providers such as pediatric nurse practitioners, neurodevelopmental pediatricians, neurologists, and speech and language pathologist whose services fall under the medical benefit and medical network.

And we have psychiatrists, psychologists, psychiatric nurse practitioners, and behavioral consultants whose services fall under the mental health benefit and mental health network. It can be confusing and frustrating for families to not always be able to get equal coverage or access to all of our services because of these insurance limitations.

We are updating our last insurance blog from 2012 with some current answers and tips for families.

If your child is a patient at Seattle Children’s Hospital we encourage you to view Billing and Insurance: Frequently Asked Questions.

If your child is receiving mental health services (which includes various therapies and medication management) at Seattle Children’s Hospital, we encourage you to view Seattle Children’s Insurance Coverage for Mental Health Services.

If you are wondering whether your insurance plan will cover mental health services at the Autism Center, please view the Seattle Children’s Mental Health Insurance page which lists those plans that do not contract with us for mental health care. If your insurance plan is not on this list, then most likely it will cover care with us.

If your child has Washington Medicaid please visit the Washington State Department of Social and Health Services page to learn more about mental health services available to your child.  You can visit the ABA Services page to learn more about the Medicaid ABA benefit.

While the resources above are specific to Washington and Seattle Children’s Hospital, there are some things we can recommend that may apply more generally:

  • Always call your own insurance company to find out your benefits. Usually, this number can be found on the back of your benefit card, listed as “customer service”.
  • Medical benefits and Mental Health benefits are different! Ask your customer service representative, ”What are my mental health benefits?”
  • Cost can vary significantly between “in-network” and “out-of-network” providers. Although some providers may know if they are “in-network” with your insurance, you should always verify this yourself.
  • Before making a change in insurance – check to make sure your current providers or providers you would like to be able to see – are in the new plan’s “network”.


Tips on AAC from SLPs – Resolve to Get Visual

AACResolve to Get Visual: Five Tips on Augmentative and Alternative Communication (AAC) for Speech Language Pathologists (SLPs).

It’s the beginning of a new year and a great time to resolve to kick off 2016 by implementing visual supports for all kinds of learners, particularly those with ASD. It takes a little elbow grease but the outcome is worth the investment. Plus, it doesn’t have to be any more complex than getting your own day planner ready for the start of a new year. Here are five can-do reminders that address common barriers to diving in to AAC from Jo Ristow, SLP at Seattle Children’s Autism Center.

AAC is NOT always high-tech (such as the iPad). It’s true, high-tech AAC can be an investment of dollars and time but AAC can be as cheap as pencil and paper or a good printer. You already have all the tools you need to start. While iPads and apps have revolutionized the field, AAC predates iPads by many years. Plus, there are some advantages to low-tech AAC – nothing needs to be charged, it’s more portable, less expensive, can go with you to the pool, and no one wants to steal picture symbols! Not every kid needs an iPad but every kid needs a means of communicating. One child I work with uses a portable dry-erase board. It can be that easy.

 AAC doesn’t have to be difficult to learn. AAC runs the gamut from high-tech, cutting edge programs to extremely simple and accessible picture and written supports. Just think visual. Can you draw smiley and frowny faces to talk about feelings? Can you print out three clip art pictures to offer choices? Can you use visuals that you already use in your own life such as a calendar or planner to support your students’ communication and understanding? If so, you’re on your way to using AAC! The most important thing is to just start trying to use visuals in your lessons and expand from there. Aim for a robust language system, but starting small is better than not starting at all.

Also, remember that our students benefit from our mistakes. I rarely have to directly teach a child to use the backspace button on a high-tech AAC device because they see me doing it so frequently that they learn from my mistakes. And searching fruitlessly for a vocabulary word is a nice way to naturally demonstrate behavior-regulation strategies such as taking a deep breath, modeling self-talk, and being persistent. Or sometimes it is a great way to model words like “Whoopsie!” “This is hard!” or “I’m frustrated!”

AAC is not that different from traditional therapy. Good therapy skills transcend the tools you’re already using.Techniques such as modeling, expanding utterances, and providing communication temptations are all at play in AAC. You basically have to remember to point to visuals while using the traditional techniques.

More students than you might think benefit from AAC.We all use AAC in our lives. When’s the last time you picked up a phone and called someone? Today we tweet, text, IM, email. Think how emojis enhance your message! Studies show that kids who don’t talk benefit from using AAC and AAC may jumpstart verbal ability. For those who are verbal, AAC can increase the quality of their communication whether it’s speaking in longer sentences or communicating for different purposes such as asking questions or sharing ideas.

AAC doesn’t have to be a lot of work to implement. It’s true that the success of the AAC user depends a lot on the adults in their environment using and modeling but you don’t have to reinvent the wheel. In this age of technology, accessing pre-made AAC is as simple as running a Google search and hitting the PRINT button. The high-tech devices are more and more robust and evidence-based in their organization of vocabulary, so it is often a matter of creating a few buttons and trying it out.

Like all New Year’s resolutions, it’s ok to start small and measureable and work your way towards something that could make life a lot easier. Who knows where you’ll be this time next year!

Some handy websites for AAC:

For tons of resources and ideas:

For lesson plans and activities:

For recommendations from an AAC master:


Mindful Monday – Kindness


Whether it’s allowing another driver to “cut in” in traffic or the person with just five items to do the same in a grocery store line, it seems little acts of kindness are getting harder to find as our hurry-up-and-wait lives get even more rushed. You know how it feels when someone cuts you off or barges in – we feel annoyed at best and outraged at worst.

Here are some tips for dealing with the daily indignities we all encounter:

  1. Remember it’s not personal. No one is singling us out with the intention of taking advantage of us. We’re all busy and self-centered about making it through our day.
  2. If someone does slight you, and it triggers a strong emotion, try and imagine what’s in their head at that moment. I recently held a door open for a customer in a restaurant nearby and she didn’t say thank you or even acknowledge me. My immediate reaction was “how ungrateful!”. I took a breath and considered that she may have just left our center and been told her child had autism or left her doctor’s office where she was told she had cancer. 
  3. If your immediate reaction is to respond in a less-than-kind way, try a mental “halt!” and do the opposite. Say or do something kind. Pay attention to the reaction you then get. 

Quote of the Week:

“Be kind whenever possible. It is always possible.”

– His Holiness the Dalai Lama