Kinder Growth DIR/Floortime Medicaid Services

by Affect Autism

This Week’s Guest

Sari Levin is a Special Educator who has worked with families for a long time and is the Clinical Supervisor of Kinder Growth where they provide home-based DIR/Floortime services throughout New Jersey and are the first accredited DIR/Floortime organization in the state of NJ. Sari has her Advanced DIR certificate. Also with us today is returning guest, Occupational Therapist Stephanie Peters who is the Clinical Director with Kinder Growth and teaches certificate courses as a DIR Training Leader with ICDL. Today we will be discussing the Parent Support services that Kinder Growth provides including direct coaching, and what their accreditation means to them.

Bonus Insights

Medicaid DIR/Floortime Services

Kinder Growth provides DIR/Floortime services across the state of New Jersey for children who have an autism diagnosis who are on Medicaid insurance. Medicaid is the first one to cover DIR/Floortime and this is providing families with services they otherwise wouldn’t have had access to. Many parents have found Kinder Growth by searching terms like autism intervention, autism therapy, New Jersey services, etc.

Many families searching for autism services are looking for ABA (Applied Behaviour Analysis) because that’s what they’ve heard of and then they come across DIR/Floortime. Sari comments that it’s the best mistake they’ve ever made! Many families also look for other services after they’ve had a bad experience with behavioural services and stumble across Kinder Growth. They’re thrilled to learn that their dreams of being a parent can be supported through DIR services that work so well, Stephanie says.

Medicaid covers services until age 21. The most common age population Kinder Growth serves is between age 2 to 4 but they have older children as well in their services, Sari explains. The services are based on family need. Some families need support on the evenings and weekends while others want support and guidance during the weekdays because their children is at home, Sari continues. The families are technically able to get about 30 hours per week. It goes according to a six-month authorization and every six months they re-evaluate to see if the child or family needs more or less services.

Stephanie is the Clinical Director for DIR/Floortime services at Kinder Growth which is what guides the entire process with families. Sari and Stephanie are the coaches for the caregivers and supervise the therapists who work with the children. The parents are also part of the Floortime sessions with therapists. Sari and Stephanie constantly collaborate with each other with families as well.

Caregiver Support

Every family is told up front that parent coaching is part of their services. There are weekly meetings, but parents can also request more than one meeting per week, Sari explains. They meet online/remotely for the convenience of the families. The meetings are rewarding, Sari shares, especially when the parents have their light bulb moments connecting with their children. The meetings are for the caregivers. It shouldn’t be a stress and they can look forward to them. It’s a safe space where they can share and get their answers.

I talked about how parents have different readiness levels for accepting parent support. I booked my DIR/Floortime therapy sessions and was thrilled to do the dishes when the therapist arrived instead of participating in the sessions. It is a process for parents. It takes awhile for parents to get past the false narrative of autism and realize that their child’s brain just works differently. It’s a shift to move from their child needing therapy to ‘make them better’ versus receiving support. Stephanie and I did a podcast called The Realization Phase where we discussed this process and I’ve done a podcast about Floortime parent support.

DIR/Floortime lets the caregivers know that as the primary Relationship (‘R’ in DIR), they can interact with their child in a different way to make the child feel safe, which is the perceived sense of safety in the relationship. It’s difficult when parents’ Individual differences (‘I’ in DIR) clash with the child’s ‘I’. Floortime about figuring out how the caregiver can feel connected with the child so they see and understand each other. The parent support is about having a space to feel with another person that this is really hard and sometimes I don’t understand this. Stephanie says that it’s a horrible feeling when you’re stuck, and it’s so valuable to not feel alone and be shown tools that help it feel good to connect with your child where you can be the agent of your child’s developmental mobility.

The goal is to empower a parent to let them know they’re the most important person in their kid’s life. It’s not about anyone else coming in. It’s the process of understanding what to do to interact differently, then to process and reflect on it.

Stephanie Peters, DIR Expert

Kinder Growth has a therapist delivering Floortime services in the home which looks different and parents might have questions. This gets the conversation started, Stephanie explains. Even having a person who speaks the same Floortime language is really important. The goal of Floortime is to not need the person coming into the home because the parent has everything they need, and this can be scary for parents. They might ask, “How am I in control of my child’s meltdown?
How do you begin? What is the process?

The Process for Parents

Sari asked herself, do we create a process or blue print for our therapists? No. It’s an organic process where we meet the caregivers and talk about how it’s going. What do they see with their therapists and what did they find interesting about the session? The parent might say, “My therapist did this and I wasn’t sure what they were doing or why it made a difference, but my child loved it. What was that about?” They might get the parent to try it and then ask next session how it went. Parents learning Floortime can get overwhelmed with all of the terminology so this is an organic way to start to learn about it.

Sari says they can ask the caregiver, “What did you see?” You can bring it up and they have a context for what they’re learning, such as their child throwing, for instance. We have the opportunity to explore the ‘why’ behind the ‘what’ and have the luxury to just think about why their child is doing what they do, Stephanie explains. There is no roadmap. Every interaction is different. Every day is different. There’s no straight forward path. Which sensory system needs more support? “This worked last time, but not this time. What do I do now?” Offering the space to be curious to foster a deeper understanding who your child is is what they do at Kinder Growth.

On the spot coaching example

I challenged Sari and Stephanie to provide some on-the-spot parent coaching to me. They accepted! I explained that since school began this month, my son has not wanted to go and talks about not wanting to go nonstop (even though he has a great time when he’s there). He sends me a firing squad of questions about when I’ll pick him up, what we’ll do after school, what comes the next day, the next, and the next, etc.

First, Sari and Stephanie acknowledged my experience. Stephanie asked if I could think about what has helped in the past for him to transition. What has he been able to be co-regulated by? I joked that distraction tends to work, such as when a teacher will say that his friend has a new board game inside and he is excited to go find out what it is. I explained how I try to provide the sense of safety by bridging to the next connection, as Dr. Neufeld describes, such as saying I can’t wait to see him later, etc.

Stephanie discusses how we don’t want him to be able to transition because he’s distracted because the core reason why the dysregulation is happening is not addressed. It will just be diverted to the next time. He’s not experiencing that expanded emotional range, the feeling of the stress response, and the feeling of feeling ok. As we practice that, the window of dysregulation gets smaller and smaller, she explains. Distraction might work, but it is a band-aid. She reassured me to not feel guilty about trying to co-regulate instead of running away. The need won’t go away if I run away while he’s dyregulated.

Sari says to get out ‘our old friend AFFECT’, as Jackie Bartell says. She suggested that I echo back with affect what he says: “No school.” This gives him time to think about what he’s saying and re-process it with Mom there, Sari explains. In the car I empathized, “You don’t want to go to school today. Ugh. It’s so hard.“, etc. Sari says to try to keep him in that moment. When I do that, he jumps to the next thing. He switches the subject. I can say, “You’re thinking about after school but right now you don’t want to go to school” to help regulate the feeling of fear he has. Sari says to just focus on the ‘no school’ with minimal language and see how he’ll respond. I replied that he’ll start filling in the space with the next thing. It’s hard for him to sit in discomfort.

Stephanie wonders about his visual and visual spatial processing. When he’s visualizing the things to come, is it that much harder for him to anticipate what his body will be feeling in this different space? What does ‘no school’ mean? “No teacher, no friends, no colouring, no school building?” This could be a way for him to co-regulate, Stephanie says. She suggests saying, with a lot of affect, “No playing outside? No playing outside. Ugh. No friends today. Awww. No friends.

He’s wound really tight in that moment, she explains. There’s still a lot of strength that’s happening, though. He’s talking and engaged. What we’re doing by leaning into the idea of ‘no school’ is slowly loosening the knot. As it opens, it will naturally unravel. He can explore what kind of thinking and feeling goes with it. The challenge of Floortime is when to push. Maybe it’s expanding on what ‘no school’ means. It means staying home with Mom, but what does the school part of ‘no school’ mean? I explained how at ICDL’s parent support meeting, Colette Ryan said that when he doesn’t feel safe, he’ll cling to what he feels most safe around: Mom.

We also discussed how it is important not to talk my son out of what he doesn’t want, such as asking, “But what about your friends? But what about (this and that) that you like so much?” Stephanie stresses that if someone’s in FEDC 1, the first Functional Emotional Developmental Capacity of being dysregulated, you can’t reason with them at the higher developmental capacities.

How can we sit in it with him in this concept of ‘no school’ and ponder what it means? He was getting out of the car with me and walking towards school with me, and having a full on conversation with me, even if he was crying. So even though he was at the higher capacities while he was dysregulated, I hear Sari and Stephanie coaching me to support him at the lower capacities.

Sari also suggests revisiting it after school: “This morning you didn’t want Mommy to leave? You were sad.” Wait for a response. “And then you went to school and you played and had so much fun.” Wait for a response. “Then Mommy picked you up.” Sari finds it organizing for the child. Revisit it again later describing the details, visualizing what he did in school.

Visualizing it. Interesting point. Dr. John Carpente mentioned to me when we were meeting to discuss our upcoming presentation at the ICDL DIR/Floortime Conference that my son seems to have compartmentalized ideas and is finding it hard to sequence. This might be the same thing that’s happening with his feelings, as Mike Fields mentioned in the Unpacking Aggression podcast. It’s hard to sequence feelings, he explained.

My son can enact what he saw in the Mario Kart game in play, so we know he’s symbolic, but Dr. Gil Tippy had said to me that my son still seems to be enacting what he sees in his memory rather than coming up with his own new ideas. Stephanie says she’s thinking about it from a whole body sense: Knowing where your body is in space and being able to anticipate how something feels.

This connects with the intensity that you need to receive the input, the timing that your body registers it, and the discrimination of what to do with it. All of those are tied into praxis to then have new ideas–to know when to change something, to know what to do next, how to end it, and what happens when that idea is done. It’s all interconnected.

She talks about the ‘neurodiversity piece’ in thinking. In your mind’s eye what do you see? There’s so many ways people think (e.g., in music, pictures, or words, etc.). Stephanie suggests I figure out what will help him visualize. For some kids, seeing pictures helps to visualize what will happen. Eighty percent of learning is visual, she explains, so if that’s hard for you, you’ll have a narrow window of what you can tolerate. Your regulation window will be small, she adds, and knowing how to navigate a 3D world is complex.

Helping and being curious with him about what his body might expect might help him have the agency and ownership and know what he’ll be expected to do and what he can do, Stephanie continued. But if he’s stuck in fear, she offers, we want to loosen up that emotional experience and help him to be able to shake himself out of it. One to two words going back-and-forth and being curious is where to do it, she suggests.

I explained that I liked how Sari and Stephanie made me feel supported and understood. Parents are struggling trying to understand their child. Having that support to help feel understood and have something to work on for that week is really valuable.

Empowering Caregivers

Sari says sometimes there are sessions where they barely talk about the child and the parent just needs to feel heard. They always get the question, “Am I a good Mom?” They support parents in their journey so they can, in turn, support their child. They are also empowering parents to be able to question other therapies their child has if it doesn’t feel right. In terms of learning the DIR Model and Floortime, they support caregivers as things come up. 

Sari and Stephanie find ways to insert what each capacity is. The parents slowly learn about the Functional Emotional Developmental Capacities (FEDCs) and they really end up understanding development and what has to happen before a child can talk a lot, for instance (in a way that’s not overwhelming to them). Sari says they’re there to slowly give them the information in a way they can understand.

1st DIR-accredited organization in New Jersey

I asked Sari what it means to her to be the first DIR-accredited organization in NJ and how it reflect on their clients’ impression of Kinder Growth? Sari says that when they were building up Kinder Growth, they were looking into the accreditation process and felt it would give them credibility. The biggest thing was that there is a standard they have to keep to. It’s given them that standard to provide the highest quality therapy that they can. The accreditation also helps with staying up to that standard as well with the Fidelity Scale and other support that shows the organizations where they should be at in terms of providing quality services.

Sari continues that their Floortime practitioners are up to par and her and Stephanie are there to support them on their own Floortime journeys and learn with them as well. This all tells the clients that Kinder Growth is up to a certain standard, especially for families new to Floortime. It gives them assurance that they’re a certified company, so they can trust Kinder Growth. From the therapists’ viewpoint, they know they’re getting good experience from a quality company.

Stephanie adds that the access to Floortime is hard. NJ has a lot of resources that a lot of places don’t have, but there are still a lot of places in NJ that don’t have access. It’s great that it’s covered to get such good support. It shouldn’t cost so much to help your child. She only hopes that Medicaid and other coverage continues to grow.

Check out Kinder Growth

At Kinder Growth’s website you can also find an easy-to-read blog at the bottom of the home page with information for parents. Sari says they often get calls from outside of NJ asking for resources, including calls from overseas. They are happy to answer questions to support parents outside of NJ and provide them with links to resources. I also suggested seeing the Services page of this website for DIR providers around the world.

This week’s PRACTICE TIP:

This week let’s take note of the amount of times we feel discouraged or down and could use some support, or the times where we have celebrations with our children that those in our life just don’t understand that we would love to share with someone who gets it. ICDL’s free online Parent Support group is there for you! 

For example: Did you have a rough day because your child was sick and dysregulated and you felt that you couldn’t do anything to help make them better? With cold season in full swing, it’s so hard to see our children all stuffed up or coughing and not being able to make them better. Maybe our child was having meltdowns all day while we had stuff to take care of and it made it a hard day for both of you. Maybe your child ate a new food or gestured something to you to communicate that they hadn’t done before and you would love for it to be appreciated. 

Thank you to Sari and Stephanie for explaining the Medicaid DIR/Floortime services they offer including the parent support piece. I hope that you learned something valuable and will share it on Facebook or Twitter and feel free to share relevant experiences, questions, or comments in the Comments section below.

Until next time, here’s to choosing play and experiencing joy everyday!

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