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A weekly show from the folks at East Lansing Info breaking down all the news and happenings in East Lansing, Michigan.
WDBM East Lansing.
Introduction:This is East Lansing Insider brought to you by ELI on Impact eighty nine FM. In this show, we break down all of the news and happenings in the East Lansing community. And now, today's East Lansing Insider.
Anna Liz Nichols:Hello, everyone, and welcome back to this week's episode of East Lansing Insider. I'm Anna Liz Nichols, deputy editor of East Lansing Info. And this week, in honor of April Autism Acceptance Month, we're talking with Paul Doher, who serves as national director of clinical quality for Acorn Health, which has ABA autism therapy centers in several states, including here in the capital area where Paul is based. Thank you for joining me today, Paul. Can we talk just a little bit about what you all do at Acorn?
Paul Doher:Yeah. At Acorn, we, do applied behavior analysis therapy, also called ABA. And, for people who are unfamiliar with what that is, if you boil it down to its simplest terms, it's the science of learning. And so, essentially, what we do is when, an individual comes to us and they have a diagnosis of autism, we do an assessment. We identify where are the areas of strength, where are the areas they need to grow in, and then what we do is we create a treatment plan.
Paul Doher:And the treatment plan outlines all of our goals, And we really focus on teaching to the core deficits of autism. So developing communication, developing social skills, and helping reduce any maladaptive behaviors that could interfere with their ability to be independent in life. And then what they do is they come to us for therapy throughout the week. And the amount of therapy they get can vary depending on how many skills they need to learn and then the severity of their behaviors. Some kiddos come for ten hours a week, some up to forty.
Paul Doher:On average, our kids are coming for about twenty five hours a week for therapy, and what that means is they are they're set up with a one on one, therapy with a behavior, technician. And this behavior technician delivers the therapy. And so, essentially, they're working and teaching those skills. And then while the behavior technician does that, we have behavior analysts who oversee the therapy. And what they do is they're the ones who wrote the treatment plan, and then they are watching therapy to make sure that it's being done correctly.
Paul Doher:They're writing new goals, and they're teaching the RBTs how to run new programs, collecting data, and all of those things. Oh, another component of what we do is the family guidance, which is essentially where we're teaching the caregivers how to utilize the different strategies that we do during therapy so that someday the client can graduate from therapy, and then they don't need us anymore. And then when the caregivers are with them, leading their lives, then they have the tools to either intervene on behaviors when they come up or teach a skill.
Anna Liz Nichols:I know the focus of Acorn is is is children. Is there a reason what should people maybe understand about, early interventions with autism? When we talk about awareness and acceptance, how crucial is it to promote awareness and acceptance when it comes to identifying autism for children and having these interventions?
Paul Doher:It's really important that we begin as soon as we can. The earlier that we can begin delivering therapy, the better outcomes we're gonna see later in life, for a couple reasons. One, that's when the brain is the most malleable. It's able to learn the most and adapt. But, also, the second reason is as we get older and we don't have the therapy, our children are gonna develop some behaviors that may not be the most socially appropriate, but they're effective at getting their needs met.
Paul Doher:And then the longer learning history those behaviors have, the harder it's gonna be to teach them to learn a new behavior that may be more appropriate and also still get their needs met. So what we really try to focus on is ensuring that people in the community have, have access to knowledge and information about what autism is, what does it mean for their future, and what's available to you, and then also to begin acting on it quickly. Because, we wanna make sure that when the kiddos come to us for therapy, we can get them as early as we can. Because like I alluded to earlier, we want them we don't want ABA to be a part of their whole entire life. We want to just be part of it where they can teach them the skills that they need to be more independent so eventually they can graduate, and then they can do less intrusive things, like maybe social skills groups or after school clubs or activities like that.
Anna Liz Nichols:So before we started the episode, you and I talked about how it's autism awareness month, but some of the language around how we talk about autism has shifted to Autism Acceptance Month. I was wondering if you could talk a little bit about how maybe the conversation surrounding autism has changed maybe in the last decade and what Mid Michigan, Michigan, and and beyond could do to better promote awareness and acceptance of autism.
Paul Doher:So, yeah, within you know, autism is still a mystery. Right? We still don't fully understand, you know, how it develops. Like, we have a lot of indicators about the genetics and the environmental factors. But, as time has gone on, we've been getting better with our diagnosis and identifying autism earlier and earlier.
Paul Doher:And so what that looks like is you're gonna see the rates of autism increase. You know, I I when I began in the field around 2016, I think they were saying autism was about one in a hundred and ten children. And now it's about one in fifty or, you know, one in thirty depending on, what publication you look at. And so to a lot of people, that could be alarming to say, like, wow. Are the rates of autism increasing?
Paul Doher:When what we're really seeing is probably better diagnosis processes are in place and more awareness of what autism really is. And the fact that it is a spectrum where some individuals are very lightly impacted by their disability and some more significantly impacted. And so as we've kind of gotten better with our science and understanding, about what autism looks like, we are now aware of it. Right? And so now we're moving into this acceptance component where we know it exists.
Paul Doher:We know it's a prevalence in our communities and and it impacts individuals across all socioeconomic statuses and races and genders. And so now it's let's make sure that we can provide these individuals with the tools that they need to live more independent lives. You know, autism impacted their life through no fault of them or their family or anybody. Right? It's a genetic, disorder that was passed on.
Paul Doher:And in the rate to which it impacts, people can really fluctuate. You know, there can be twins who have autism, and one can be higher functioning or have more skills than the other. And so I think at this point, we wanna make sure that the resources so families getting what they need, therapy being delivered in a really quality manner. And as far as what we can do in Michigan, I think it's it's continuing to expand upon our services. We have, a lot of providers in the state that are great, and we've got a lot of people who wanna do good and do and and have a a meaningful impact.
Paul Doher:And I think what we need to do next is continue to work with, everybody in the community on how we make sure that these services aren't denied or restricted and how to make sure that because someone had autism, they can get access to things that anybody with another medical diagnosis could get access to. So one of the things that we're really working on through an organization I work with called MIBAP, which is, Michigan Behavior Analysis Professionals, is we're working to get a bill passed where we can have ABA therapy delivered in the school setting. And so right now, the way that the ABA, Medicaid law is written is they're very separate. School occurs in one setting, ABA occurs in another, and they rarely overlap. And what we're trying to do is we're trying to make sure that therapy can be delivered in in the school setting where when the kiddos need it.
Paul Doher:What we're not trying to do is say everybody needs it. We're gonna push in tons and tons of people. What we're saying is there's certain individuals who the schools maybe struggle to meet their needs, and those are the times where we would like to get in there and to provide support to the school personnel. And to be there to kinda help out and round out that client's educational, experience so they can get, teaching from their instructors, but then also maybe some maybe a therapy to help overcome some barriers to access teaching. So that's one of the things I think we could do, in this state.
Paul Doher:Now things like this law have been, we're building it off of other laws in other states that have been successfully passed. So Colorado and Indiana, they allow ABA to be delivered within the school setting. And so we're using that as a model, and we're just working to make sure that it's, that something that can be accessible to everybody.
Anna Liz Nichols:Are there any common misconceptions about autism that have still survived to this day despite this increasing awareness for autism.
Paul Doher:Yeah. There's some of the ways that autism can be portrayed in popular culture. It is something that we have to be careful about understanding that it's just one example of what autism could look like. There's a saying that when you've met an individual with autism, you've met one individual with autism, meaning that you're gonna meet somebody else who have autism, and, their behaviors will manifest in completely different ways. So sometimes when people see things in pop culture where an individual with autism has, like, a, a savant ability.
Paul Doher:Right? They may under they may think that, well, everybody with autism has some sort of savant abilities. When actually when you look at the data, the population of individuals with autism who, have savant like abilities is the same ratio as it is in the general population. But because in movies and TVs, it's kind of sensationalized to highlight this individual who can do something very fascinating, it can kind of, people people can can run run with with it. It.
Paul Doher:So that would be one misconception. Another misconception would be that, some individuals with autism are incapable of learning or developing skills. And what we've seen in ABA therapy is that's not true, is we're able to teach them and we can break down teaching into really small, manageable pieces and build on it slowly over time. And we can get them to the point where they can get their needs met. Now, our goal isn't to take this person with autism and try to make them a typically developing.
Paul Doher:That's not what we wanna do. We just wanna make sure that they can gain skills so that they can get their needs met and they can socialize in a manner that is appropriate for them.
Anna Liz Nichols:Given on a federal level some of the conversations happening about autism, specifically from, you know, our secretary of health, Art Blake Junior. What are some of the things you guys are combating or you guys are interested in when autism has been a topic and there's a lot of information and misinformation happening surrounding We
Paul Doher:wanna make sure that people can understand what's misinformation, how do I identify it, and how do I find out the truth. Because you're right. Unfortunately, we're in a time where things are being said, maybe not necessarily for the right reasons, You know? And so, when things are taken out of context or or misinformation is put out there for a different, someone's, their own personal gain or goals or for whatever reason it could be, we can't control that. What we can't control though is is what we listen to and what do we accept as truth and what do we question.
Paul Doher:And that's one of the things we're working with caregivers on is identifying like, yeah, you hear something that it sounds scary and the or, you know, it sounds like, I don't is that true? And, you know, one of the things I like to tell caregivers is if your gut tells you that feels off, then explore that feeling. Don't just take it at face value. And so we give them, access to things about how do you process the information. Like, there's different acronyms you can use to identify, like, how do I take what's been told and figure out what maybe the truth is?
Paul Doher:And there's even websites where you can look up, clippings from newspapers or, like, online articles that tell you, you know, here's how it's represented from a more conservative side of here's how it's represented from a liberal side, and here's what it looks like in the middle. So people can kind of look and see, like, how the different information is being delivered to them based on what people want them to hear.
Anna Liz Nichols:Have there been, you know, Michigan State policies that have been enacted in the last decade or so that have been having a positive impact on on the autism community, kids, families, all that.
Paul Doher:As far as, like, putting things into state law, nothing I'm familiar about within the last few years that have been a significant impact. There are things that when we work with MDHHS about getting rate increases that we try to to make sure that our frontline staff who are delivering that one on one therapy, are paid in a way that represents the hard work that they're doing. When you think about it, we are entrusted with taking care of a little child's life for three, four, five, six hours a day to teach them things that are really important. And so it's, something that takes a very unique person, and, it's a lot of work. And so we wanna make and so we're working with MDHHS to increase our rates of reimbursement to ensure that we can reflect on these direct care workers who are putting in all that effort, to get you know, to reward them for their hard work.
Paul Doher:We also wanna make sure that we are being very careful about how we utilize the money that's being given to us because we don't want any abuse, or, you know, fraud, or waste to come through. And so we're very cautious about how many hours we prescribe, how it's delivered, when are the start and stop times for sessions, what occur in sessions to make sure that, not only is everything done with quality, but we're also we're not, devying outside the lines of what's appropriate to use. Is
Anna Liz Nichols:there anything else about Acorn specifically that you would want people to know as far as its impact on the Mid Michigan community, its presence in the Mid Michigan community?
Paul Doher:I would like people to know at Acorn that we put the child first or the individual because we can treat individuals up to 21 or even older if their insurance would cover the the therapy. But we wanna make sure that the very first interaction we have with them is a quality building relationship. It's really important that when we're working with an individual with autism that we start with building a rapport with them, and we emphasize safety, dignity, respect, and intellivisibility. And so what we mean by that is we tell our staff, if you were to take your recordings of you working with these individuals and you put them on TV for the whole world to see, would you be proud of it? And we want them to always answer yes.
Paul Doher:And so that's where our first focus is to make sure that the person is treated right to begin with. Because in the history of ABA, that hasn't always been the case. Now not specific to Acorn, but as individuals have gotten older able to share their experiences in ABA in the past, it wasn't pleasant, and and it's the truth. This is what they experienced. And so our way of responding to that is saying, we're gonna put the person first.
Paul Doher:We're gonna make sure that we treat them the way they deserve to be treated, and then the teaching can come next. And then from that point, we're really focused on the quality of it. We wanna make sure that when we're delivering a therapy, it's the right way it should be done. And so we have a lot of processes in place to make sure that that that happens, a lot of oversight and things like that.
Anna Liz Nichols:What can, you know, neurotypical or is that the still the correct language? I apologize.
Paul Doher:You know, there's you're it depends on who you ask. I I think that neurotypical is an appropriate way to refer to it.
Anna Liz Nichols:What can, you know, just all of us do in our day to day lives, in our relationships with others to support, you know, our peers with autism and and promote, you know, their place in our lives?
Paul Doher:I think it starts at a young age. And if we're if you're a parent, I think getting your child involved in a peer to peer program through their school where they can be paired up with an individual with a disability, as just like a a friend and a buddy, someone that they can interact with. Because many of our, the people with autism that we work with, they struggle to form and develop, maintain social relationships. And so these peer to peer programs are really great for beginning to teach those skills, but then also for the other individuals to become aware that this is a disability that exists. Because sometimes autism may not be, you know, readily apparent, until someone engages in a behavior that it's a little bit quirky.
Paul Doher:And then our minds are like, that looked a little bit different. And then as we get to expose a little bit more, we're like, okay, this is who they are. And we start to accept that and and we're not afraid of them. Right? Because I think if we're not exposed to working or being around people with autism, we, you know, we may be unsure.
Paul Doher:We may just let misconceptions take over. So if we can have our young people in schools engage in peer to peer where they're interacting with others and growing relationships with them from an early age, I think that's gonna make huge differences later on in life for everybody. Yeah. I think also too, if we're in the community, it's recognizing that, parents who have a child with autism are going to struggle, and their children's behavior does not mean they're a bad parent. Their behavior just means that they're trying to get their needs met, it may not be the most socially appropriate way, but it's an effective way.
Paul Doher:Right? And so parents are constantly working on teaching their children and working with their AB therapists, and it takes time. Right? It's not like they're gonna come into therapy for a day or a week or a month, and then all these behaviors have changed. It takes a lot of repetition.
Paul Doher:And so understanding that they're struggling sometimes and the judgmental looks or the comments and things like that, only add to the struggle. And it doesn't necessarily mean that we have to jump in and say, let me help you out. I think it means we don't have to stare. We don't have to to suggest things when they're not needed to be suggested. If there's an opportunity to help out, we could offer, like, is there something I could do?
Paul Doher:You know? If we feel like it's appropriate, if there's, a big episode occurring. But oftentimes parents are navigating these things the best they can. And then I think also too is accepting these individuals for who they are. So like one thing we talk about at Acorn is, our children who come to see us are engaged in stereotypy, which is a restrictive and repetitive behavior.
Paul Doher:It's something that occurs, you know, over and over again. You may see individuals, do specific movements, make specific sounds, or say statements over and over again. And and what we say is that's what makes them unique. It's who they are. It's part of their personality, and we're not gonna tell them stop.
Paul Doher:Don't do that. We're going to smile at them, embrace it, make eye contact, and let them know that we appreciate who you are. And so I think doing things like that is just understanding that there's gonna be people in this world who have a different experience than us, and it doesn't mean that they're better or worse. It just means that, you know, the things that they go through, we may not quite understand.
Anna Liz Nichols:Paul, how long have you been with Acorn Health?
Paul Doher:So I've been with Acorn, so working, in an ABA clinic since 2016. And then prior to that, I taught in public schools as a special education teacher for children with autism for five years.
Anna Liz Nichols:Yeah. What drew you to making your career about special education? Were there any personal experiences you had that led you to this work?
Paul Doher:A little bit. I don't have anybody in my family who has been impacted by autism. But growing up when I was in, in elementary school, middle school, and high school, where I went, they had a very large special education program. And so I was constantly exposed to in class with interacting with individuals with disabilities. And so it wasn't stigmatized.
Paul Doher:Wasn't wasn't something I was, didn't know anything about. In fact, we had a lot of opportunities to interact with and build friendships with people, with autism and and different disabilities from my my experiences. I wouldn't say necessarily that was, like, the the catalyst. I think, you know, if I was to boil it down, I think that, I consider myself very fortunate to have, you know, in a lot of things in my life. You know, I've got a really good support system, a great family, and there's a part of me that always just wants to give back.
Paul Doher:And I think that's probably where it stems from is is, I know there's individuals out there who struggle and need support and help, and and I really wanna be the one to do that.
Anna Liz Nichols:How many families or or kiddos per year does Acorn serve in I know there's lots of locations, but maybe do you have a MidMichigan number? Yeah.
Paul Doher:Oh, in MidMichigan Or Michigan. Thinking, like, Lansing, East Lansing.
Anna Liz Nichols:Yeah.
Paul Doher:Yeah. So we have one location in Okemos, and we serve about 30 to 40 clients at that location. But throughout the state of Michigan, we have dozens of of locations in Grand Rapids, the East Side of the state, up north in Northern Michigan. One of the things we wanna do at Acorn is we wanna make sure that, AB is accessible to anyone, and so that includes people who live in rural, parts of of Michigan. So we've set up in Northern Michigan quite a few locations in places where there is not a lot of support.
Paul Doher:Sometimes our staff drive one to two hours to go see a kiddo, and that takes a and that's a huge commitment on their part. And I just think it's a it it demonstrates that we don't we don't think where you live should be a barrier to what you get, and so that's why we wanna do that. So I know that within our whole organization. So we have, we're within seven different states, and right now, we serve about 1,700 clients.
Anna Liz Nichols:Awesome. Well, thank you so much for talking with me today. This has been a lovely conversation. I really appreciate your time.
Paul Doher:Yeah. Well, I appreciate you reaching out and getting us set up, and so thank you very much.
Speaker 2:East Lansing Insider is brought to you by ELI on Impact eighty nine FM. We are on the web at eastlansinginfo.news and impact89fm.org. Thanks for listening.