I have been thinking for a few months that Sweets may potty train pretty soon. She signs CHANGE when she wants you to change her diaper, or will even go fetch a clean diaper and bring it to you. She also signs DIAPER and POTTY. She has been going for long stretches between wet diapers, and even wakes up dry from nights and naps more and more fequently. Munchkin potty trained right around this age too - she was in unders full-time during the day the week of her 2nd birthday. Sweets will turn two in 6 weeks.
When I first mentioned to my husband that I thought Sweets might be ready to potty train soon, he was pretty skeptical. He said "She's late doing everything else, I don't know what makes you think she's going to potty train." I just took the baby potty out from storage and showed it to her. Some time later, we were talking about Sweets' delays, and my husband said that he feared that we would start to expect less from her, and that she would therefore do less. I said, you mean like potty training? After that he was 100% supportive of potty training!
So I brought the baby potty into the living room and we have been leaving her naked from the waist down at home more often. She has been sitting on the potty at diaper changes, but she hasn't "done" anything in it yet. That is up until last night!
She was in the bath and started signing POTTY and frantically making noises - "Mmmmh! Mmmmh!" I didn't want her to potty in the bath, so I took her out and dried her off and sat her on the potty. She sat, but didn't go. When she stood up, she held her knees together and grabbed her crotch and made the frantic "Mmmmh! Mmmmh!" noises again. Then she sat and stood up and repeated the noises. This cycle went on for about 20 minutes interspersed with some playing. It was like she knew she had to go, but she didn't really know what to do about it and was trying to hold it in. Eventually, she got so frantic that I sat her on the potty and played "If You're Happy And You Know It" with her to occupy her hands and try to keep her still. And when she got up, there was a big poop in the potty!
We worry about her cognitive abilities, because she still doesn't succeed at the shape sorter or simple puzzles. But she can communicate many things through signing, which shows us that she understands language and remembers the signs and knows how to use them. So maybe she will be able to potty train just fine, despite her other delays!
Wednesday, March 16, 2011
Monday, March 14, 2011
orthotics and more, updates
We just had another PT eval and Sweets tested at 20 months for Stationary (37%), 17 months for Locomotion (5%) and 18 months for Manipulation (16%). Her overall gross motor is 10%. Her PT said that she thinks that the type of test that was used judges her more harshly than where she really is though.
Her balance is quite poor though, and she falls frequently. The PT has recommended that we have her fit for orthotics for her feet because she pronates when she walks - turns her feet to the edge, which affects her balance. The orthotics would fit in her shoe and would prevent her from rolling her feet. The PT thinks that we will probably get Sure Steps, but the orthotist will make the final call as to what kind would be best.
Sweets also had an OT eval last week because our coordinator saw that she wasn't able to do the shape sorter when she observed a recent developmental therapy session. In the OT eval, Sweets was able to pick up pennies off the floor just fine and put them in the slot in a piggy bank with either hand. The assessment showed that her problem is not really with her fine motor skills as much as with her cognitive skills. She doesn't perform the shape sorter or puzzle well because she doesn't know where the object should go, not because her hands can't manipulate it properly. So, she doesn't need OT therapy, and will just continue with the developmental therapy with a new goal of working on problem solving toys and helping her persist to her level of abilities without giving up.
Our speech visits are going up from two 30-minute sessions per week to two 45-minute sessions. It costs us the same either way, so that's nice.
We have been dealing with a conflict regarding the billing for the therapies. We started 9 months ago and this is the first time we've gotten a bill for anything, and we really had to harrass them for it. But when I got it, it was not the amount that I expected, it was about double. I called them up and told them they did my bill wrong, and they said that I was the one who was wrong. Both therapy agencies did it the same way, so I was thinking that they must be right and I've been wrong this whole time about how much this was going to cost us. I complained to my early intervention coordinator and after 2 weeks they got back to me and told me I was right and the agencies were wrong and they were going to make sure they fixed it for me. So that is nice. I wonder how many people they are messing up the bills on that don't even realize. They were basically double billing my insurance and the state for the same amount, so that they were collecting about 1.5 times what they should.
We are going to run out of insurance-covered therapy visits. We only get 75 per year (increased over 50 last year because we upped our insurance option) and we are using 3 per week now. She actually gets 4 per week - 2 speech, 1 PT, 1 developmental - but the developmental is free for us. So we are going to go off the insurance for a while and just pay out of pocket so that we don't use up all of our visits right away. Right now we are still on a 40% sliding scale rate, but we think that will go up next time they re-evaluate us in June, so we figure we should pay the out-of-pocket now rather than later.
We are still looking into the developmental preschool for her, but we are finding that their therapists aren't on our insurance, so that is a complication. They say that we CAN use our own therapists, but they really think it's better if we use theirs.
Her balance is quite poor though, and she falls frequently. The PT has recommended that we have her fit for orthotics for her feet because she pronates when she walks - turns her feet to the edge, which affects her balance. The orthotics would fit in her shoe and would prevent her from rolling her feet. The PT thinks that we will probably get Sure Steps, but the orthotist will make the final call as to what kind would be best.
Sweets also had an OT eval last week because our coordinator saw that she wasn't able to do the shape sorter when she observed a recent developmental therapy session. In the OT eval, Sweets was able to pick up pennies off the floor just fine and put them in the slot in a piggy bank with either hand. The assessment showed that her problem is not really with her fine motor skills as much as with her cognitive skills. She doesn't perform the shape sorter or puzzle well because she doesn't know where the object should go, not because her hands can't manipulate it properly. So, she doesn't need OT therapy, and will just continue with the developmental therapy with a new goal of working on problem solving toys and helping her persist to her level of abilities without giving up.
Our speech visits are going up from two 30-minute sessions per week to two 45-minute sessions. It costs us the same either way, so that's nice.
We have been dealing with a conflict regarding the billing for the therapies. We started 9 months ago and this is the first time we've gotten a bill for anything, and we really had to harrass them for it. But when I got it, it was not the amount that I expected, it was about double. I called them up and told them they did my bill wrong, and they said that I was the one who was wrong. Both therapy agencies did it the same way, so I was thinking that they must be right and I've been wrong this whole time about how much this was going to cost us. I complained to my early intervention coordinator and after 2 weeks they got back to me and told me I was right and the agencies were wrong and they were going to make sure they fixed it for me. So that is nice. I wonder how many people they are messing up the bills on that don't even realize. They were basically double billing my insurance and the state for the same amount, so that they were collecting about 1.5 times what they should.
We are going to run out of insurance-covered therapy visits. We only get 75 per year (increased over 50 last year because we upped our insurance option) and we are using 3 per week now. She actually gets 4 per week - 2 speech, 1 PT, 1 developmental - but the developmental is free for us. So we are going to go off the insurance for a while and just pay out of pocket so that we don't use up all of our visits right away. Right now we are still on a 40% sliding scale rate, but we think that will go up next time they re-evaluate us in June, so we figure we should pay the out-of-pocket now rather than later.
We are still looking into the developmental preschool for her, but we are finding that their therapists aren't on our insurance, so that is a complication. They say that we CAN use our own therapists, but they really think it's better if we use theirs.
Friday, February 25, 2011
Billing Troubles
I have been talking to the PT and SLP billing people this week. This is the first that I've heard from them about my bills for services since we've been in CDSA since last June. We have been asking for bills for some time and didn't want to get surprised. They are now telling me that the amounts that I understood that I have to pay are incorrect, and that I have to pay more.
My understanding was this: The provider would send the bill to insurance first, my insurance would pay and then I would have a copay. Then, based on my sliding scale, CDSA would pay a % of that copay and I would pay my %. In 2010, my copay was $25 and my sliding scale was 40%, so my understanding was that I would be responsible for $10 per session. In 2011, we upgraded our insurance to the more expensive plan (specifically because of these therapies) and our copay is now $20, so my understanding was that my copay for this year would be $8 per session.
The therapy groups say this is incorrect, and I am being charged $19.55 per SLP visit and $15 something for PT (I haven't seen the PT bill yet). They are telling me that they bill to insurance first, then when the BCBS payment comes in they bill the *remainder* to CDSA (not the BCBS copay, but the total amount minus the BCBS payment), and then CDSA determines their allowable and pays their % and I pay my %.
The actual breakdown of charges/payments on my SLP bill (for a 2010 session) are:
Charge from provider $100
BCBS payment $19.37
CDSA payment $29.33
Family owes $19.55
Write off $31.75
My interpretations are:
Total BCBS allowable $44.47
Total CDSA allowable $48.88 (I owe 40% of this)
Total collected by provider $68.25
My questions:
1) What is the actual way that my share is computed, and why is it different from what I thought? This was apparently not adequately explained to me in the beginning.
2) How can the provider collect more than the BCBS contracted allowable rate after billing through insurance? BCBS pays them based on the allowable charges, and I would think they are not allowed to try to collect the balance (besides the copay) after filing it through insurance. It seems to me that by billing BCBS, they are agreeing to the BCBS allowable amount, yet somehow through this arrangement they are able to collect 1.5 times the BCBS allowable amount. If I was not working with CDSA, they would not be able to collect more than the allowable rate from me. If my CDSA sliding scale rate was 60% instead of 40%, would I be asked to pay $29, instead of the lower BCBS copay? That makes no sense.
3) What is the CDSA allowable based on? Is it affected at all by how much my insurance pays? Will my amount owed per session actually change at all for 2011 due to my change in insurance level? BCBS is paying an additional $5 to the provider now (lowering my "copay" from $25 from $20), but will this just end up being another $5 for the provider? Will it just decrease my actual payment by $2 (40%)?
4) If I was not going through insurance at all, what would my payment be through CDSA? If I have to pay $20 for the session, and my BCBS copay would be $20 anyway, what is the benefit of my going through both CDSA and insurance? I might as well just go through my insurance alone and pay the $20, or go through CDSA alone. In that case, I wouldn't have to worry about whether the providers are on my insurance or not (such as the CLC therapists), or about running out of visits with my insurance.
5) Why must it take so long to discover how much I actually owe? We have been with CDSA for 9 months, and I am just now starting to see bills and discovering that my bill is double what I expected this whole time.
My understanding was this: The provider would send the bill to insurance first, my insurance would pay and then I would have a copay. Then, based on my sliding scale, CDSA would pay a % of that copay and I would pay my %. In 2010, my copay was $25 and my sliding scale was 40%, so my understanding was that I would be responsible for $10 per session. In 2011, we upgraded our insurance to the more expensive plan (specifically because of these therapies) and our copay is now $20, so my understanding was that my copay for this year would be $8 per session.
The therapy groups say this is incorrect, and I am being charged $19.55 per SLP visit and $15 something for PT (I haven't seen the PT bill yet). They are telling me that they bill to insurance first, then when the BCBS payment comes in they bill the *remainder* to CDSA (not the BCBS copay, but the total amount minus the BCBS payment), and then CDSA determines their allowable and pays their % and I pay my %.
The actual breakdown of charges/payments on my SLP bill (for a 2010 session) are:
Charge from provider $100
BCBS payment $19.37
CDSA payment $29.33
Family owes $19.55
Write off $31.75
My interpretations are:
Total BCBS allowable $44.47
Total CDSA allowable $48.88 (I owe 40% of this)
Total collected by provider $68.25
My questions:
1) What is the actual way that my share is computed, and why is it different from what I thought? This was apparently not adequately explained to me in the beginning.
2) How can the provider collect more than the BCBS contracted allowable rate after billing through insurance? BCBS pays them based on the allowable charges, and I would think they are not allowed to try to collect the balance (besides the copay) after filing it through insurance. It seems to me that by billing BCBS, they are agreeing to the BCBS allowable amount, yet somehow through this arrangement they are able to collect 1.5 times the BCBS allowable amount. If I was not working with CDSA, they would not be able to collect more than the allowable rate from me. If my CDSA sliding scale rate was 60% instead of 40%, would I be asked to pay $29, instead of the lower BCBS copay? That makes no sense.
3) What is the CDSA allowable based on? Is it affected at all by how much my insurance pays? Will my amount owed per session actually change at all for 2011 due to my change in insurance level? BCBS is paying an additional $5 to the provider now (lowering my "copay" from $25 from $20), but will this just end up being another $5 for the provider? Will it just decrease my actual payment by $2 (40%)?
4) If I was not going through insurance at all, what would my payment be through CDSA? If I have to pay $20 for the session, and my BCBS copay would be $20 anyway, what is the benefit of my going through both CDSA and insurance? I might as well just go through my insurance alone and pay the $20, or go through CDSA alone. In that case, I wouldn't have to worry about whether the providers are on my insurance or not (such as the CLC therapists), or about running out of visits with my insurance.
5) Why must it take so long to discover how much I actually owe? We have been with CDSA for 9 months, and I am just now starting to see bills and discovering that my bill is double what I expected this whole time.
Tuesday, February 22, 2011
CLC
I visited CLC yesterday, the inclusive daycare that our CDSA coordinator suggested we look into. Overall it seemed fine. I wouldn't say it wowed me, but it is a 5 star center. It's in an older building that wasn't built to be a daycare. The windows are pretty high, so the kids can't see outside. The playground is nice enough with a slide with a ramp and steps, and a tricycle path. The director seemed very knowledgeable about special needs, and seemed to have a very nice relationship with the kids and staff. They prefer that we use their therapists, but we aren't sure if they are covered by our insurance. I asked about cloth diapers, and she said they haven't had a kid in cloth since 1994! But she said she would look up the requirements and she was sure we could work it out. She also said it would be possible to start Sweets for 3 days per week when she turns two, and then switch her full-time once Munchkin starts kindergarten. That way we could secure a spot before the August rush, and not have to send Munchkin to the home daycare without Sweets.
In other news, I thought we were going to have the OT eval yesterday afternoon, but it turned out to just be paperwork. The coordinator seemed really flaky, and I felt like I had to be on top of everything. We were having a meeting about OT, but she forgot to even have me sign the OT papers until I asked. She didn't get anywhere with getting the speech therapist to agree to 1 hour sessions, but we might get two 45 min sessions at least.
In other news, I thought we were going to have the OT eval yesterday afternoon, but it turned out to just be paperwork. The coordinator seemed really flaky, and I felt like I had to be on top of everything. We were having a meeting about OT, but she forgot to even have me sign the OT papers until I asked. She didn't get anywhere with getting the speech therapist to agree to 1 hour sessions, but we might get two 45 min sessions at least.
Friday, February 18, 2011
A long chat
Yesterday I had a long chat with our CDSA coordinator.
1- We originally asked for one 60 minute speech session per week, but the speech therapist said they only do up to 45 min sessions. Instead, she suggested we could do two 30 min sessions per week to get the full 60 mins. This was approved by CDSA and is what we have been doing. Unfortunately, it means we have to pay double the copay, one for each visit. Apparantly, it also means CDSA has to pay double. Our coordinator wanted to switch back to once per week. I explained to her that I had asked the speech therapist a few weeks ago if she thought we should move to once per week, but her opinion was that she thinks Sweets really needed the full 60 minutes per week. I don't want to give her less therapy just because of money if her therapist thinks she really needs more. In the end, the coordinator agreed that we would do one of two things. A- Get the therapist to do one 60 minute session per week, even though she says they don't do that. B- If we are going to do two sessions per week, make them 45 min sessions, since it costs the same to us either way. So, either way, we'll be getting more therapy for our dollar.
2- The coordinator wanted to know what the PT is working on with Sweets, because she thought that Sweets had met her PT goals. We talked some about her PT goals, such as #7 - "Will have advanced motor skills so that she can go across uneven surfaces and eventually be able to run" which I don't think she's met. I know that the PT takes her outside to walk on the grass (uneven surfaces) and that they also work on steps. This week, the PT said that they worked on the ladder to the slide, and that Sweets should be able to climb up and help pull herself up with her arms, but that she isn't doing it. The PT and I have also noted that Sweets can walk well, but that she is still unsteady and falls down a lot. I wonder if she has balance issues, or if she is just over-confident right now. The coordinator asked some questions about sensory issues because that can lead to balance problems, but I haven't noticed any sensory issues.
3- The coordinator sat in on the DT session yesterday. She noticed that Sweets is interested in the shape sorter, but is not really able to do it. She recommeded an OT eval. I didn't really think fine motor was an issue for her, but I don't mind having an eval to check it out. We scheduled it for Monday, since I'll be home with the kids for Presidents Day.
4- We also talked about whether the home daycare environment is going to continue to be the best option for Sweets. Right now, except for Munchkin 2 days per week (and Munchkin will be in kindergarten starting this summer), Sweets is the oldest kid there. The other two babies are 10 and 18 months younger than Sweets. The boy who was 6 months older left 4 months ago, leaving Sweets without a real peer role model. Particularly because of her delays, it would be good for her to see other kids model age-appropriate behaviors. The coordinator believes that now that Sweets is getting older and is walking, that the balance may be ready to tip from the benefits of the small group home care (which is great for an infant) to the social interactions with peers. I think that I agree with this.
My original thought was that we could send her to TLS, where Munchkin goes, but the coordinator suggested we look into another center, CLC. CLC is an integrated center for kids with special needs and typical children. I am familiar with this concept because Munchkin was at PK as an infant (where we met our home daycare provider), which was the same way. They try to keep a 50/50 balance between kids with an IFSP/IEP and without. They have a therapy room and their own therapists on staff. This center also has a contract with the public schools so that if Sweets qualifies for a developmental classroom (once she is 3) then the public schools would pay her tuition at this center during the school year and we would only have to pay for summers. They have two classrooms there with spots for 12 kids in each, with one lead teacher and two assistant teachers per class, so nice ratios too. CLC goes age 2-5, so we could theoretically move Sweets in 2 months at her birthday if we wanted to. It seems most practical though, to start her there when Munchkin starts kindergarten, esp because Munchkin would still be at our home daycare 2 days per week until then (she doesn't have a full-time slot at TLS). If Munchkin gets into year-round school, it would be very convenient, because CLC is right next door and even shares a parking lot with that school! I will be taking the tour at CLC on Monday, since I have off for Presidents Day. I didn't even know about this place until yesterday, but it sounds really good so far!
1- We originally asked for one 60 minute speech session per week, but the speech therapist said they only do up to 45 min sessions. Instead, she suggested we could do two 30 min sessions per week to get the full 60 mins. This was approved by CDSA and is what we have been doing. Unfortunately, it means we have to pay double the copay, one for each visit. Apparantly, it also means CDSA has to pay double. Our coordinator wanted to switch back to once per week. I explained to her that I had asked the speech therapist a few weeks ago if she thought we should move to once per week, but her opinion was that she thinks Sweets really needed the full 60 minutes per week. I don't want to give her less therapy just because of money if her therapist thinks she really needs more. In the end, the coordinator agreed that we would do one of two things. A- Get the therapist to do one 60 minute session per week, even though she says they don't do that. B- If we are going to do two sessions per week, make them 45 min sessions, since it costs the same to us either way. So, either way, we'll be getting more therapy for our dollar.
2- The coordinator wanted to know what the PT is working on with Sweets, because she thought that Sweets had met her PT goals. We talked some about her PT goals, such as #7 - "Will have advanced motor skills so that she can go across uneven surfaces and eventually be able to run" which I don't think she's met. I know that the PT takes her outside to walk on the grass (uneven surfaces) and that they also work on steps. This week, the PT said that they worked on the ladder to the slide, and that Sweets should be able to climb up and help pull herself up with her arms, but that she isn't doing it. The PT and I have also noted that Sweets can walk well, but that she is still unsteady and falls down a lot. I wonder if she has balance issues, or if she is just over-confident right now. The coordinator asked some questions about sensory issues because that can lead to balance problems, but I haven't noticed any sensory issues.
3- The coordinator sat in on the DT session yesterday. She noticed that Sweets is interested in the shape sorter, but is not really able to do it. She recommeded an OT eval. I didn't really think fine motor was an issue for her, but I don't mind having an eval to check it out. We scheduled it for Monday, since I'll be home with the kids for Presidents Day.
4- We also talked about whether the home daycare environment is going to continue to be the best option for Sweets. Right now, except for Munchkin 2 days per week (and Munchkin will be in kindergarten starting this summer), Sweets is the oldest kid there. The other two babies are 10 and 18 months younger than Sweets. The boy who was 6 months older left 4 months ago, leaving Sweets without a real peer role model. Particularly because of her delays, it would be good for her to see other kids model age-appropriate behaviors. The coordinator believes that now that Sweets is getting older and is walking, that the balance may be ready to tip from the benefits of the small group home care (which is great for an infant) to the social interactions with peers. I think that I agree with this.
My original thought was that we could send her to TLS, where Munchkin goes, but the coordinator suggested we look into another center, CLC. CLC is an integrated center for kids with special needs and typical children. I am familiar with this concept because Munchkin was at PK as an infant (where we met our home daycare provider), which was the same way. They try to keep a 50/50 balance between kids with an IFSP/IEP and without. They have a therapy room and their own therapists on staff. This center also has a contract with the public schools so that if Sweets qualifies for a developmental classroom (once she is 3) then the public schools would pay her tuition at this center during the school year and we would only have to pay for summers. They have two classrooms there with spots for 12 kids in each, with one lead teacher and two assistant teachers per class, so nice ratios too. CLC goes age 2-5, so we could theoretically move Sweets in 2 months at her birthday if we wanted to. It seems most practical though, to start her there when Munchkin starts kindergarten, esp because Munchkin would still be at our home daycare 2 days per week until then (she doesn't have a full-time slot at TLS). If Munchkin gets into year-round school, it would be very convenient, because CLC is right next door and even shares a parking lot with that school! I will be taking the tour at CLC on Monday, since I have off for Presidents Day. I didn't even know about this place until yesterday, but it sounds really good so far!
Tuesday, February 8, 2011
New signs
Sweets has learned some really useful signs this week: HELP and HURT. She has actually been doing HELP for a little while now, but we just figured out what it meant. She clasps her hands together in front of her and then moves them up and down repeatedly. But now we have figured out that it's her way of signing HELP, and that is a really useful sign! She uses it all the time now! She also learned HURT this weekend. She fell down and got hurt on Friday night and I showed her the sign. Then when she fell down on Saturday, she used the sign to show me! It was awesome (the signing, not the hurting of course!). She also learned to sign BERRY this weekend, though she signed it better on Saturday morning than she did on Sunday and Monday. She is starting to pick up signs really quickly now, and it's so nice for her to be able to tell me what she's thinking! On Monday she signed CHANGE to me to tell me she wanted a new diaper. I layed her down on the hardwood floor to change her, and she signed COLD to tell me the floor was cold! It's just so nice to be able to get this level of communication from her!
Friday, January 28, 2011
21 months - 10 words, 25 signs
We count 10 words that Sweets can "say" now at 21 months:
Baby = "Bee Bee"
Bye Bye = "Ba Ba"
Cheese = "Gzzzh"
Dada = "DaDa"
Done = "Duh"
Hi = "Ha"
Mama = "MaMa"
Night Night = "Ni Ni"
Uh-Oh = "Oh Ah"
Up = "Buh"
She has 25 signs now that we count:
BYE-BYE
HI
MILK
MORE
DONE
EAT
FINISHED
BATH
DIAPER
DOG
NO
YES
DRINK
BOOK
WAIT
UP
BABY
BED
CHEESE
PHONE
CRACKER
SHOES
SOCKS
COLD
POTTY
Baby = "Bee Bee"
Bye Bye = "Ba Ba"
Cheese = "Gzzzh"
Dada = "DaDa"
Done = "Duh"
Hi = "Ha"
Mama = "MaMa"
Night Night = "Ni Ni"
Uh-Oh = "Oh Ah"
Up = "Buh"
She has 25 signs now that we count:
BYE-BYE
HI
MILK
MORE
DONE
EAT
FINISHED
BATH
DIAPER
DOG
NO
YES
DRINK
BOOK
WAIT
UP
BABY
BED
CHEESE
PHONE
CRACKER
SHOES
SOCKS
COLD
POTTY
new coordinator
Today I met our new CDSA coordinator. Our old one moved to a different county. She seemed nice. I felt like she hadn't read Sweets' file though. I had to tell her our whole history. She didn't know that Sweets got other therapies, or that we needed a new developmental therapist. She asked if we thought we even needed to keep getting developmental therapy, and I said that we wanted to keep it, and at least it can't hurt. So now she's on top of getting us a new therapist and I should hear from her Monday about that. She said she wanted to have Sweets re-evaluated though to see if she still needed it. She offered that they could do the eval after her 2nd birthday, because the expectations go up at that point, making it more likely that she would test as delayed. I think that she would test as delayed anyway, but I guess that's a good idea.
I also asked about moving speech therapy to once a week for 45 minutes, instead of twice a week for 30 minues. We have to pay copays each time, and we only get 75 therapies per year on our insurance, so we don't want to use them all up now. But the therapist said that she thinks we should stick to 2x30 minutes because she thinks Sweets needs the full 60 minutes. So, we'll do that. I don't want to be cheap about it, if that's what she needs.
I also asked about moving speech therapy to once a week for 45 minutes, instead of twice a week for 30 minues. We have to pay copays each time, and we only get 75 therapies per year on our insurance, so we don't want to use them all up now. But the therapist said that she thinks we should stick to 2x30 minutes because she thinks Sweets needs the full 60 minutes. So, we'll do that. I don't want to be cheap about it, if that's what she needs.
Wednesday, January 26, 2011
New therapist... again
I was happy that we were getting a new developmental therapist because I wasn't crazy about the old one. We saw the new therapist last week for the first time and I liked her. We had the session at our house because it was MLK day and we were off work, and I think it worked nicely to have it at home. So, now I just got an email from the new therapist that she found another job with another agency. So now we have to find *another* new therapist. And meanwhile, with all the confusion, Sweets has only had developmental therapy twice in the past two months. :(
Friday, January 14, 2011
No diagnosis
My Sweets has global delays in motor, speech, and maybe cognitive. It's a little hard to measure cognitive without speech. The doc said that if she was just delayed in one thing, they wouldn't worry about it because kids tend to learn one thing at a time. But since she has global delays, that is more concerning. She had her first steps and first words both around 18 months though, and has been really doing a lot of new things since then, so we are seeing a lot of progress now. The big question then, is whether there is something medical going on, or whether she is "just a late bloomer" as so many people like to tell me.
We've had a bunch of tests, including a karyotype (test for things like Down Syndrome), blood tests for muscular dystrophy and thyroid problems, evals for autism and neurology, and everything has tested okay so far. The most recent test was a DNA microarray which tests for small scale DNA copy number variances, and that just came back normal as well. So, we have no answers, but since everything is testing negative, and she is starting to do a lot of new things, we are now on a watchful waiting program and not testing anymore for now. The docs say that even if she were diagnosed with something, we are already plugged in to the early intervention therapies that we would need to get anyway, so the diagnosis isn't as important for now. But a diagnosis could be important later, in order for her to keep getting services once she ages out of early intervention. Or, she could be just a late bloomer and she will catch up by then anyway.
We've had a bunch of tests, including a karyotype (test for things like Down Syndrome), blood tests for muscular dystrophy and thyroid problems, evals for autism and neurology, and everything has tested okay so far. The most recent test was a DNA microarray which tests for small scale DNA copy number variances, and that just came back normal as well. So, we have no answers, but since everything is testing negative, and she is starting to do a lot of new things, we are now on a watchful waiting program and not testing anymore for now. The docs say that even if she were diagnosed with something, we are already plugged in to the early intervention therapies that we would need to get anyway, so the diagnosis isn't as important for now. But a diagnosis could be important later, in order for her to keep getting services once she ages out of early intervention. Or, she could be just a late bloomer and she will catch up by then anyway.
new developmental therapist
We are getting a new developmental therapist next week. We talked to the agency, and the boss said that she had received several similar complaints about this therapist and that she was actually going to reassign all of her clients to other therapists and let her go. So I guess I wasn't the only one who felt that way. The boss said that she didn't want us to feel just okay about our therapist, she wanted us to really love our therapists and think they are great. And I do think our other two therapists are really good, it was just this one that I didn't feel super warm about. So, we get a new one next week!
In other news, the speech therapy is going really well! I'm very happy with the therapist now. We are seeing a lot of new signs and sounds since we started. The physical therapist sees a lot of progress and says she thinks Sweets will graduate from PT some time this spring or at least before her yearly eval in June.
In other news, the speech therapy is going really well! I'm very happy with the therapist now. We are seeing a lot of new signs and sounds since we started. The physical therapist sees a lot of progress and says she thinks Sweets will graduate from PT some time this spring or at least before her yearly eval in June.
Monday, December 6, 2010
neurology
We had a neurology appointment and while the doc said he didn't see anything really concerning in Sweets' exam, he did order a blood test for a microarray. She has unexplained developmental delay, so I guess it's possible that this test might detect a reason behind it.
Friday, December 3, 2010
child led therapy?
We have a developmental therapist who I don't really love, but I don't think she's necessarily bad either. I just think that she's not very child-led, and therefore misses opportunities to make the therapy more enjoyable for Sweets. I don't sit in on all the sessions, so maybe things are different when I'm not there too.
Example: Last time, she had it on her agenda to work on stacking with blocks. Sweets was not really interested in doing that and was trying to play a mimicking game where she was copying the sounds the therapist was making. The therapist let her do this for a minute, but then insisted that she work on blocks, so Sweets screamed and threw a tantrum. She did eventually work on the blocks though, but she also had a really hard time with it because they were lego-style blocks, and she can barely stack regular square blocks.
When the therapist came in, Sweets immediately started crying and was tearful for most of the session. The therapist said, "That's because she knows that I make her work!" In some ways, I understand that making her do these things even when she doesn't want to may be helpful for learning the skills. I feel a little uneasy about it, but then I wonder if she's right and that's what's necessary. But it just seems to me like it doesn't have to be a negative experience. She could have followed her lead and used the mimicking game for therapy purposes - at least that's what I would have done.
So, I really wonder, how child-led can I reasonably expect the therapist to be with her?
Example: Last time, she had it on her agenda to work on stacking with blocks. Sweets was not really interested in doing that and was trying to play a mimicking game where she was copying the sounds the therapist was making. The therapist let her do this for a minute, but then insisted that she work on blocks, so Sweets screamed and threw a tantrum. She did eventually work on the blocks though, but she also had a really hard time with it because they were lego-style blocks, and she can barely stack regular square blocks.
When the therapist came in, Sweets immediately started crying and was tearful for most of the session. The therapist said, "That's because she knows that I make her work!" In some ways, I understand that making her do these things even when she doesn't want to may be helpful for learning the skills. I feel a little uneasy about it, but then I wonder if she's right and that's what's necessary. But it just seems to me like it doesn't have to be a negative experience. She could have followed her lead and used the mimicking game for therapy purposes - at least that's what I would have done.
So, I really wonder, how child-led can I reasonably expect the therapist to be with her?
Tuesday, November 9, 2010
speech therapy goals
I am feeling much better about our speech therapist now. Today I got a "Plan of Care" packet from her, which I have not gotten from our other therapists, but now I want to ask for it. It details her background for therapy and the goals they will be working on. It says they are working with a diagnosis of "Mixed Expressive-Receptive Language Delay", and "Severe" is marked as the degree of delay. That's the first I've seen anyone mark her with any kind of diagnosis, so that seems like progress, even if it's just descriptive.
Her short-term goals seem specific enough, so I thought that was good too.
*Expand her sound repertoire and frequency of vocalization by imitation of sounds during floortime activities with 80% accuracy across 3 consecutive sessions
*combine single sounds to form syllables 5 times during a therapy session with 80% accuracy
*use signs along with sounds to request "more," signal "all done" or to choose between activities with 80% accuracy across 3 consecutive sessions
*identify common objects in her environment by pointing, matching, or choosing from a choice of two with 80% accuracy across 3 consecutive sessions
In related news, she is doing really well with walking and is now walking about 50% of the time. She impressed everyone at LLL last night because it was the first time they have seen her walk. :)
Her short-term goals seem specific enough, so I thought that was good too.
*Expand her sound repertoire and frequency of vocalization by imitation of sounds during floortime activities with 80% accuracy across 3 consecutive sessions
*combine single sounds to form syllables 5 times during a therapy session with 80% accuracy
*use signs along with sounds to request "more," signal "all done" or to choose between activities with 80% accuracy across 3 consecutive sessions
*identify common objects in her environment by pointing, matching, or choosing from a choice of two with 80% accuracy across 3 consecutive sessions
In related news, she is doing really well with walking and is now walking about 50% of the time. She impressed everyone at LLL last night because it was the first time they have seen her walk. :)
Friday, November 5, 2010
speech therapy looking up
I attended the speech therapy session today and am feeling better about the speech therapist. She seemed very positive and cheerful. I feel like maybe the negativity I perceived when I talked to the early intervention coordinator was maybe just a miscommunication through a chain of people. In therapy today, the therapist tried to get Sweets to say "ba" for different things that start with B - ball, book, block, bubbles. We know she can say "ba ba" for bye-bye, so the therapist is trying to expand on that. Sweets didn't do it, but the therapist was fine and I saw what she was going for. So, I'm feeling good again. :)
Thursday, November 4, 2010
speech therapy twice per week
This morning I signed the papers for her to be changed to two 30 minute sessions per week instead of one hour long session. I will have to pay the copay for each one though, so that's double the copays. We are going to try this for 2-3 months and then probably move back to once per week. Hopefully by then she will be comfortable enough with the therapist to work with her for longer. My husband or I are also going to try to attend her therapies as much as we can at the daycare. I am already trying to attend her other therapies at least once per month each. So at this point she's going to have 4 therapies per week: 2 speech (30 min) + 1 physical (60 min) + 1 developmental (60 min).
Wednesday, November 3, 2010
speech therapy snag
Hmm. So here's the report from the first therapy session.
The speech therapist came right after the developmental therapist - they basically just did a hand-off. The speech therapist was new to Sweets and was alone with her because they were at daycare, so I wasn't there. We expect that she's not going to take to a stranger right away - it took about a month for her to get comfortable with the other therapists. In the speech therapist's note to me, she mentioned that it took Sweets a little while to warm up, but that that's expected. Also that she didn't make very many noises for her during therapy, but it's prob b/c she didn't know her. Okay, seemed pretty normal to me. It sounded like it went as you'd expect.
Today I get a call from my early intervention coordinator saying that the speech therapist recommends that we cut the sessions from 1 hr to 45 mins b/c she doesn't think that Sweets will be able to do therapy for that long, and she also had concerns about how long it will take her to become comfortable. Which I don't get, because that's not really what her note to me conveyed. :( For one thing, she piggy-backed right after another therapy session, so if she thinks that my daughter can't do therapy for that long, I would think that the first thing to do would be to change the time so that it's not right after the other therapy (which I had told her when the other therapists come).
Anyway, the EI coordinator said that it was my choice. We can stick with the 1 hr sessions for a while and see how it goes, we can switch to 45 min sessions, or she also suggested doing two 30 minute sessions per week. I thought that two sessions per week would be better for Sweets getting used to the therapist more quickly, but I wonder if that means I will have to pay double the copay - one for each visit. The coordinator was concerned that they wouldn't get much done b/c if the session is 30 mins but it takes 20 mins for her to warm up, they won't have much time left to do much therapy. So I don't know about that. But I'd rather do the split session I think because then we still get the full 60 minutes per week, and it seems like more therapy wouldn't be a bad thing, and I think after a few weeks she will be used to the therapist anyway. Then the coordinator said that she doesn't know if we would be approved for the two 30 min sessions anyway though and that it's not what they usually do. Hello - she's the one who suggested it in the first place! Argh. So, she's going to check it out and see if that's a possibility and how it would work financially, etc.
Anyway, sorry for rambling. It's really just a vent I suppose. But now I feel like I'm already starting out on the wrong foot with this therapist.
The speech therapist came right after the developmental therapist - they basically just did a hand-off. The speech therapist was new to Sweets and was alone with her because they were at daycare, so I wasn't there. We expect that she's not going to take to a stranger right away - it took about a month for her to get comfortable with the other therapists. In the speech therapist's note to me, she mentioned that it took Sweets a little while to warm up, but that that's expected. Also that she didn't make very many noises for her during therapy, but it's prob b/c she didn't know her. Okay, seemed pretty normal to me. It sounded like it went as you'd expect.
Today I get a call from my early intervention coordinator saying that the speech therapist recommends that we cut the sessions from 1 hr to 45 mins b/c she doesn't think that Sweets will be able to do therapy for that long, and she also had concerns about how long it will take her to become comfortable. Which I don't get, because that's not really what her note to me conveyed. :( For one thing, she piggy-backed right after another therapy session, so if she thinks that my daughter can't do therapy for that long, I would think that the first thing to do would be to change the time so that it's not right after the other therapy (which I had told her when the other therapists come).
Anyway, the EI coordinator said that it was my choice. We can stick with the 1 hr sessions for a while and see how it goes, we can switch to 45 min sessions, or she also suggested doing two 30 minute sessions per week. I thought that two sessions per week would be better for Sweets getting used to the therapist more quickly, but I wonder if that means I will have to pay double the copay - one for each visit. The coordinator was concerned that they wouldn't get much done b/c if the session is 30 mins but it takes 20 mins for her to warm up, they won't have much time left to do much therapy. So I don't know about that. But I'd rather do the split session I think because then we still get the full 60 minutes per week, and it seems like more therapy wouldn't be a bad thing, and I think after a few weeks she will be used to the therapist anyway. Then the coordinator said that she doesn't know if we would be approved for the two 30 min sessions anyway though and that it's not what they usually do. Hello - she's the one who suggested it in the first place! Argh. So, she's going to check it out and see if that's a possibility and how it would work financially, etc.
Anyway, sorry for rambling. It's really just a vent I suppose. But now I feel like I'm already starting out on the wrong foot with this therapist.
Tuesday, November 2, 2010
speech therapy starts today
Sweets is 18 months and is delayed for expressive and receptive language and also gross motor. In the past few weeks she is starting to do a lot of new things though. She is starting to walk and now walks almost half the time and crawls half the time. She is also starting to say some new sounds and even a few words! She has doubled the different sounds she makes just recently, adding several consonants and a new vowel as well - was just MA and BA until very recently. She can now say something that sounds like "Hi" and "Bye Bye" and "Uh Oh" in context. Funny, because Munchkin's first word was "Uh Oh" too! We also sign with her and she has several new signs lately too. She's just having a growth explosion! It's very exciting!
So, she has been getting therapy through early intervention for 4 months now. She has been getting physical therapy and developmental therapy each once per week. We wanted speech therapy, but they said at the time that she was too young. We pushed again, and now we are getting speech therapy! She starts today! Woo hoo!
So, she has been getting therapy through early intervention for 4 months now. She has been getting physical therapy and developmental therapy each once per week. We wanted speech therapy, but they said at the time that she was too young. We pushed again, and now we are getting speech therapy! She starts today! Woo hoo!
Friday, October 22, 2010
Autism clinic
Sweets had her autism clinic appointment today. The doc said that while there are a few markers, like not pointing appropriately, that in the big picture she has very strong social skills (enjoys peek-a-boo, chasing, kissing, waving, etc) and that they do not see indication of autism.
As for what it is, if not autism, they still don't know. They want to see her in speech therapy, which she is scheduled to start any time, probably next week, anyway. They noted that she favors one side, and asked the neurologist to step in. He did some manipulations and reflex tests on her, and watched her try to walk with no pants on (I guess to watch her legs?). She doesn't walk independently yet (just takes a few steps), so I held her hands so she could walk for that test. He only saw her for like 5 mins, but he said he didn't really see anything alarming. He said we should still keep our full neurology eval in December though. He also mentioned that we could do an MRI on her, but that it's hard at this age and that she would have to be under anesthesia, so they'd rather wait until she's two.
The overall take-home message was just wait and see how she does with therapy. Really no new information, since we didn't really think she had autism anyway. Just confirmation of that.
As for what it is, if not autism, they still don't know. They want to see her in speech therapy, which she is scheduled to start any time, probably next week, anyway. They noted that she favors one side, and asked the neurologist to step in. He did some manipulations and reflex tests on her, and watched her try to walk with no pants on (I guess to watch her legs?). She doesn't walk independently yet (just takes a few steps), so I held her hands so she could walk for that test. He only saw her for like 5 mins, but he said he didn't really see anything alarming. He said we should still keep our full neurology eval in December though. He also mentioned that we could do an MRI on her, but that it's hard at this age and that she would have to be under anesthesia, so they'd rather wait until she's two.
The overall take-home message was just wait and see how she does with therapy. Really no new information, since we didn't really think she had autism anyway. Just confirmation of that.
Tuesday, October 19, 2010
autism eval coming up
Sweets is 18 months and will be having an eval this week at the autism clinic. I don't really think that's what she has, but that's where our ped has referred us. I hope that they can at least refer us to another specialist that might be more what we need, because I don't really know where we should be going. We do have an appointment with a neurologist in December, but I don't know if that's the right place for us either.
My daughter doesn't talk at all, or even make many varied types of noises - BA and MA are her staples, but she has recently started making sounds that approach GA and LA and P. She tests delayed for receptive and expressive language. She points, but not with meaning, like she knows when we expect her to point to something, she just doesn't know to what so she points randomly. She is not very interested in toys, but she loves any kind of paper to eat and tear up, particularly tissues or toilet paper. But, she is definitely social and cuddly. She asks for kisses by making the kissy face, she loves chasing and peekaboo, she smiles and makes eye contact. So that's why I didn't think autism clinic was really the right place for us because she doesn't really have any social issues. I mean, just because she has language delay, doesn't mean autism right? Or maybe I just don't know that much about differences on the spectrum. Oh, and she also has gross motor/tone/balance issues and doesn't walk yet (but is very close I think!).
My daughter doesn't talk at all, or even make many varied types of noises - BA and MA are her staples, but she has recently started making sounds that approach GA and LA and P. She tests delayed for receptive and expressive language. She points, but not with meaning, like she knows when we expect her to point to something, she just doesn't know to what so she points randomly. She is not very interested in toys, but she loves any kind of paper to eat and tear up, particularly tissues or toilet paper. But, she is definitely social and cuddly. She asks for kisses by making the kissy face, she loves chasing and peekaboo, she smiles and makes eye contact. So that's why I didn't think autism clinic was really the right place for us because she doesn't really have any social issues. I mean, just because she has language delay, doesn't mean autism right? Or maybe I just don't know that much about differences on the spectrum. Oh, and she also has gross motor/tone/balance issues and doesn't walk yet (but is very close I think!).
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