Alternative or Complementary Therapies and Approaches Survey Results January, 2002 In October of 2001, a survey was sent to all Part C coordinators asking them to indicate which of the therapies or approaches below would be paid for, provided, or in some other way "covered" by their state's early intervention system. Of the 56 surveys e-mailed or faxed, 25 jurisdictions responded: AK, CNMI, CO, CT, DC, DE, FL, GA, ID, IL, KY, MA, MO, NH, NJ, NV, OR, PA, RI, SC, SD, TX, UT, VT, WA Of the 17 therapies or approaches listed, only four were provided by more than 50% of those responding: aquatic therapy (56%), massage therapy (52%), sensory integration therapy (80%), and neurodevelopmental treatment (76%). Therapy/Approach # of jurisdictions that provide or pay for this service (Percent, Additional Comments) Auditory Integration 5, 20% Aquatic Therapy 14, 56% if delivered by a qualified person such as a PT, OT if OT or PT occurs in pool where child and family would normally spend time. we don't call it this, but rather include with traditional PT If performed by PT/OT location does not matter Conductive Education 2, 8% paid as developmental therapy asked once only Craniosacral Therapy 2, 8% Facilitated Communication 5, 20% not for infants and toddlers, they're too young to read Feldenkrais 0, 0% Head-shape correction helmets 2, 8% A few have been paid for around the state, but it has been difficult to justify as developmental vs. a medical issue. This is considered a medical treatment and we do not pay for it Therapy/Approach # of jurisdictionsthat provide or pay for this service (Percent, Additional Comments) Massage Therapy 13, 52% if delivered by a qualified person such as a PT, OT some therapists or EI specialists are trained, however it is listed on the IFSP as special instruction one more said "possibly" on an individualized basis usually for parent education rather than a service MOVE (Mobility Opportunities via Education) 2, 8% Music Therapy 9, 36% funded as a form of special instruction using those rates sometimes pay for a placement for interaction with typically developing peers not specifically for the service Myofascial Release 7, 28% listed as OT or PT since it is a technique they can implement if trained paid as other service &endash; this may be a technique used Neuro Developmental Treatment (NDT) 19, 76% if delivered by a qualified person such as a PT, OT, SLP we have a number of providers who have this certification, but we do not list NDT as a service. If a physical or occupational therapist has this training, he/she may incorporate it into OT or PT as listed on the IFSP. Paid at OT or PT rates listed as OT, PT, or ST on IFSP and therapist must be trained paid as other service &endash; this may be a technique used Therapy/Approach # of jurisdictionsthat provide or pay for this service (Percent, Additional Comments) Sensory Integration Therapy 20, 80% If delivered by a qualified person such as an OT Only if OT is determined to be needed to address IFSP goals, and then listed as OT services We don't specify it as SIT, but rather include with traditional OT/PT by therapist with this particular expertise it is recorded under OT services paid as other service &endash; this may be a technique used Therapeutic Electral Stimulation 0, 0% Considered a medical service and thus not funded No, but can be funded as a medical treatment under Title V Therapeutic Riding 10, 40% if delivered by a qualified person such as a PT, OT, Sp, Early Interventionist very rarely and only if provided by a OT, PT or SLP and then, only if the location is a natural environment. Paid at therapy rates. if PT is with the child, listed on IFSP as PT paid as other service &endash; this may be a technique used if provided by PT/OT, although the horse is not the key The Institutes for the Achievement of Human Potential 0, 0% Vision Therapy 4, 16% if delivered by a qualified person.   General Comments We are currently finalizing guidelines for children with autism spectrum disorders which will include mechanisms for reimbursement for ABA, Floortime, Incidental teaching, Denver model, and TEACCH models of intervention. We've built into our fiscal policies and established rates of reimbursement and personnel qualifications, in line with what we already have in place for special instruction Some of these therapies are being provided by qualified PTs, etc and are billable and accepted as physical therapy, etc. Obviously I could foresee a problem if and when a service is requested, such as therapeutic horseback riding, that is offered by someone who is not licensed or credentialed and would not fit into a standard Part C area of service. Most of these services have not been payment issues here, but our philosophy is to be flexible and do as much as possible, when it works. We may be paying for others of those listed, but because we subsume it all under the "highest standard" i.e. OT, PT, or ST, it doesn't come in on our data. If a therapist is trained and has the crednetial in any of these and the child's needs are appropriately met with the methodology &endash; then we pay. I am very uncertain about this list &endash; this is not how we approach services. The only service that we have stated as allowed other tan those listed under Part C Federal regs is "respite" as we have it defined for our state. We may at times allow payment for music therapy and families have gotten trained in infant message, but that comes under family training. This list really leans heavily towards things that someone else has to do, as opposed to specialists sharing their expertise and guiding the adults who interact with children across their day to have strategies that support a child's development and growth. Various autism approaches such as ABA, floortime, incidental teaching, Denver model, and TEACCH model As a practice, early intervention providers do not identify specific methodologies when developing IFSP goals and outcomes. As a result, while some of the listed therapeutic approaches may be used in a program with an individual child, the specific methodology would not be listed on the cover page of the IFSP. Most of the other activities might be funded on a single situation basis, but are not included in the Part C service taxonomy. Most would be considered non-traditional, experimental techniques which Part C does not fund. Aqua therapy, hippotherapy, and music therapy are considered non-traditional therapies that are not funded. PT and OT provided in a pool or riding ring would be funded. Our state does not specifically define any of these as services provided and paid for by the system. However, a licensed professional, as a method of therapy, may provide several of the approaches, including aquatic therapy, NDT, and sensory integration.   Descriptions of each Approach Auditory Integration Therapy or AIT was designed to normalize hearing. AIT begins with an audiogram to test the child's hearing. The audiogram is used to determine the proper settings for the electronic filtering devices used in AIT. During AIT, music from a stereo system is played through a specialized electronic device. The electronic device randomizes and filters the frequencies from the music source and sends these modified sounds into the trainee's ears through a set of headphones. The randomized frequencies mobilize and exercise the inner ear and brain. Aquatic Therapy (also called Hydrotherapy) is physical therapy or occupational therapy performed in the water. Aquatic Therapy utilizes a variety of physical principles to assist with habilitation/rehabilitation. These physical principles include buoyancy, hydrostatic pressure and viscosity. Water is a medium through which therapy can be provided. Water in and of itself is not therapy. Conductive Education is an educational system for the rehabilitation of people with motor disabilities caused by damage to the central nervous system. It was developed by Andras Peto, a native of Hungary, starting in 1938, with the first institute for Conductive Education opening in 1950 in Budapest. Conductive Education seeks to teach problem solving skills, for children and adults to achieve goals through effort and knowledge of their own potential. The basic elements of Conductive Education are motivation and communication, considered necessary to teach the process of problem solving. It is a center-based program, with parents expected to participate at the "early intervention phase" (age 6 months to 3 years). Expected duration of Conductive Education is from two to three years, but has ranged from 6 months to 6-8 years. Once finished with Conductive Education, it is recommended that physical and occupational therapy be used to maintain the achieved condition. Craniosacral Therapy claims to use gentle pressure to manipulate the bones of the skull to affect the craniosacral system (membranes and fluid surrounding the brain and spinal cord). It is felt that there is a "rhythm" to the flow of cerebrospinal fluid within this closed system and that any restrictions, increases or decreases, can affect a person's health. Clinicians are trained to feel the "rhythm", locate "restriction points", and enhance/assist in restoring normal rhythm for improved health. Facilitated Communication is a technique that purports to allow individuals with severe language deficits to express themselves at near-normal or normal levels. The technique involves a facilitator who supports the child's hand on a keyboard or letter board while the child types or spells messages. Feldenkrais is an educational system that develops functional awareness of the self in the environment. This method utilizes two forms of instruction: verbally directed movement sequences presented primarily to groups (Awareness through Movement); and by guiding people through movement with gentle, non-invasive touch (Functional Integration). Feldenkrais defines itself as a learning process and not a therapy technique. This process includes motor learning, relaxation and sensory integration. Head-shape correction helmets: Children, preferably those under 7 months, wear these helmets for up to 23 hours/day in order to correct any problems with the shape of their heads. Massage Therapy is a treatment technique where the provider touches the infant or young child softly over the back, extremities and face while speaking softly, alternating between verbal and non-verbal communication. MOVE (Mobility Opportunities Via Education) is a top-down, activity based curriculum designed to teach basic, functional motor skills needed for adult life within the home and community. It combines natural body mechanics with an instructional process designed to help the child acquire increasing amounts of motor independence. Music Therapy is the prescribed use of music by a qualified individual to affect positive changes in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems. Proponent of music therapy report it offers young children an unique variety of musical experiences in an intentional and developmentally appropriated manner. These experiences effects changes in a child's behavior and facilitates development of his/her communication, social/emotional, sensori-motor, and/or cognitive skills. Myofascial Release is a technique of stretching fascia, the thin tissue that covers muscles and organs in order to decrease pain and restore or improve function. The amount of stretching, the direction of the stretch and the force of the stretch is guided by feedback the clinician feels from the individual's body. Neuro Developmental Treatment (NDT) is an advanced therapeutic approach practiced by experienced Occupational Therapists, Physical Therapists, and Speech&endash;Language Pathologist. This hands-on approach is used when working with people who have central nervous systems insults that create difficulties in initiating or controlling movement. The therapist observes and feels the movements the infant/toddler can do and analyzes the areas in which there are movement difficulties. By guiding the correct movement with his/her hands on the person the therapist facilitates more functional movements. Guidance is removed, as the infant/toddler is able to perform a skill more independently and efficiently. Sensory Integration Therapy begins with an evaluation to determine if a sensory processing disturbance exists. Once the area(s) of deficits is determined, the child is provided with appropriate sensory stimulation in an effort to elicit adaptive responses to these stimuli. The sensory experiences used generally include goal-oriented play using activities that offer opportunities for sensory intake. Therapeutic Electrical Stimulation (TES) which stimulates a child's muscles while they sleep. Therapeutic Riding (also called Hippotherapy/Equine Assisted Therapy/Equine Facilitated Therapy) uses horseback riding activities where the horse becomes the tool for therapy. The movement of the horse is used to address therapy goals such as improving balance, coordination, strength, mobility, or normalization of muscle tone. Additionally, according to the North American Riding for the Handicapped Association (NARHA) the warmth and emotional bond with the horse can assists with improving confidence and self-esteem. A variety of therapeutic goals can be addressed on horseback including cognitive, physical, emotional, social, or behavioral. The Institutes for the Achievement of Human Potential uses what is typically called "patterning" as their method for speeding growth in children throug increase of visual, auditory, and tqactile stimulation. Also referred to as Doman-Delacato therapy. Vision Therapy for children with autism which includes the use of specialized color or prism glasses to correct visual perception problems. Top .