Interview conducted by Kristina (Kristy) Gasiewski, MEd, MOTR/L, BCBA
Melmark PA

Interviewees:

  • Angel Cox Crayton, M.Ed., BCBA, LBS, Behavior Analyst
  • Samantha (Sam) Chamberlin, MOT, OTR/L, Lead Occupational Therapist
  • Amanda L. Duffy, MEd, BCBA, LBS, Director of Clinical Services – Adult Programs
  • Lindsay Harre, MS, CCC-SLP, Lead Speech Language Pathologist
  • Lara Redcay, MEd, BCBA, Assistant Director of ICF/IDD Aston & Spruce / Adult Residential Services
  • Samantha Re, MABA, QIDP/Behavior Specialist Melissa A&B/Adult ICF

Introduction

Interview with Melmark Clinicians

Caption from left: Angel Cox Crayton, MEd, BCBA, LBS; Lindsay Bly, MS, CCC-SLP; Lara Redcay, MEd, BCBA; Kristina
(Kristy) Gasiewski, MOTR/L, MEd, BCBA; Samantha Re, MABA; Amanda Duffy, MEd, BCBA, LBS; Samantha (Sam)
Chamberlin, MOT, OTR/L

Kristy (Interviewer): Melmark is a multi-state, not-for-profit organization serving individuals across the lifespan who are diagnosed with autism, developmental and intellectual disabilities, acquired brain injuries, medical complexities, and other neurological and genetic disorders. Melmark is committed to enhancing the lives of individuals through individualized services. Melmark’s core commitments include compassionate care, integrity in everything we do, maintaining a highly skilled workforce, the use of evidence-based practices, creating a unified culture, and working towards best outcomes. I first came to Melmark in 2012 as an occupational therapist and worked in the school program. With Melmark’s commitment to a highly skilled workforce, Melmark has provided me with opportunities through the years and has supported me on my professional journey to becoming dual-credentialed. In addition to my master’s in Occupational Therapy, I now hold a Master of Education in Autism and Applied Behavior Analysis.

What intrigued me about Melmark is the multiple programs Melmark has to offer. While I worked in the school, I worked closely with the children’s residential programs. Melmark PA also provides a variety of adult services. While I was always familiar with aspects of these programs, it wasn’t until this past September, when I transitioned into the behavior analyst role in the adult Intermediate Care Facility (ICF) program, that I truly realized all that Melmark has to offer.

I am excited for this interview as an opportunity to show our readers a glimpse of some of the amazing professionals we have, and how they carry out Melmark’s mission when providing services to our adult clients.

Kristy: I am grateful that each of you was willing to take the time to participate in this interview. Can you share with our readers a little bit about yourself and what your role is at Melmark? Our readers will be interested in the adult services at Melmark and the different roles you have.

Lara: I joined Melmark in 2013, right after college, as a direct care staff in the children’s residential program. I transitioned into a manager position in our adult program in 2016, then quickly transitioned into a clinical role after completing my Master’s degree in Applied Behavior Analysis and Autism in 2020. I became a Board Certified Behavior Analyst (BCBA) in 2021. I continue to work with adults in my current role as the Assistant Director of the ICF program. In this role, I supervise the house supervisors of four homes, assisting with scheduling staff and training, maintaining communication with families and stake holders, supporting the development of the ISP’s and goals to ensure that we are helping the individuals increase participation and independence with important tasks (e.g., ADLs, self-medication, communication) and planning and scheduling outings in the community. Additionally, I assist and support the clinicians with developing and maintaining behavior plans to decrease the occurrence of challenging behavior and to increase appropriate and replacement behaviors. In my role, I also ensure that we remain in compliance with regulatory requirements so that we are maintaining all health and safety needs for our individuals and ensuring that we are providing active treatment for all residents. I work closely with the interdisciplinary team to maximize collaboration with all appropriate disciplines, including families, medical professionals, physical therapists, occupational therapists, and speech/language therapists.

Amanda: I began my career at Melmark many years ago working with transition-age students (14-21) in our school program. Melmark is where I discovered the field of Applied Behavior Analysis and was inspired to pursue my Master’s degree and become a Board Certified Behavior Analyst. I left Melmark to work in several private school settings. I provided consultation for public school transition services and oversaw a community-based program for adults with ASD for over 7 years. I returned to Melmark this past year as the Director of Clinical Services for our adult programs. I oversee our team of behavior analysts as well as incorporate a behavior analytic framework within our day and residential programs. I am grateful for the opportunities I had supporting school-aged children living with developmental differences, but my heart truly resides within adult services, and I feel privileged to support our individuals across their lifespan.

Samantha R.: I have worked in the ABA field for four years and joined Melmark’s team with minimal experience in the adult population. I am grateful to have the supervision and guidance that the Intermediate Care Facility department team has provided to help me grow professionally and provide the highest quality services to my caseload. My role in the adult department includes addressing both skill acquisition and behaviors targeted for reduction. Behaviors for reduction include those behaviors that interfere with the individual’s access to community settings and may also pose a risk to that individual’s safety and the safety of those around them. I work closely with Melmark’s interdisciplinary team which includes speech therapists, occupational therapists, and physical therapists as well as the medical team. Using a multi-disciplinary approach is a hallmark of service provision at Melmark.

Sam C.: I joined the Melmark team in 2020 as the first occupational therapist for the adult individuals residing in our ICF homes. My role expanded over the years to include serving many adults in our 6400 residential programs and assuming the Lead Occupational Therapist position in the department. At Melmark, our adults are primarily served within two settings: ICF, or campus-based residences, and 6400 community-based residences. Within the adult programs, I recommend and monitor adaptive equipment to allow our individuals to participate in everyday life to the best of their ability. I specialize in assisting the team to make recommendations and accessibility modifications to allow our individuals to ‘age in place’ successfully and safely. “Aging in place” refers to a growing trend among older adults preferring to live and age within the comfort and familiarity of their homes rather than moving to a residence that may be more accessible (e.g., no stairs, ramps in place). It is important that we acknowledge adults’ preferences and their desire to stay in familiar environments.

Angel: I’ve been employed at Melmark for over six years. I started at Melmark as a behavior technician in the adult community homes while I pursued my master’s degree in applied behavior analysis with a concentration in autism at Endicott College. I have been a behavior specialist at Melmark for the last two years. I provide services to adults in our adult day program and adults in our 6400 residential programs. I’ve recently became a board-certified behavior analyst with my license to practice in the state of Pennsylvania within the last year.

Lindsay: I’ve been with Melmark since 2018. I joined as the first in-house speech language pathologist for the adult intermediate care facility (ICF). Prior to my arrival, all adult clients received outpatient speech if they needed therapy. It became clear when I first arrived, that my attention needed to be focused on maintaining health and safety through evaluation of aspiration (i.e., when food/drink goes down the wrong way resulting in illness) and diet tolerance across the program. My focus is to maintain optimal mealtime safety, while still promoting least restrictive diet levels. Now as the department grows and I have another speech language pathologist (SLP) to assist with the adult caseload, we can evaluate communication needs and provide alternative and augmentative communication for many of our clients who were otherwise limited in their options.

Kristy: Your work is impressive, and your professional growth truly fits in with Melmark’s mission. Melmark’s mission is ‘Every Individual. Every Day’. What does this mean to you and how do you see it applied in your current role?

Lara: “Every Individual. Every Day.” means to me that we work to increase the quality of life for all the individuals that we serve, and for whatever that means to them. Every individual is incredibly different and has different needs. In my current caseload, I work with individuals who are between the ages of 19 and 78; all require different supports. I love that our mission requires us to look at the individual as a whole and really work together as a collaborative team to improve the quality of life for all individuals. The focus areas for the younger adults are to increase their independence, participation, or tolerate engagement with daily tasks and activities like brushing teeth, showering, and taking their medication. With the older adults we focus on trying to maintain the skills they currently have, as well as adjusting their environment due to their increasing physical limitations as their bodies age. For example, when working with a client who used to walk with the use of a cane, but now requires a wheelchair, we would focus on maximizing their independence as much as possible(i.e., using a power wheelchair versus a manual wheelchair).

Amanda: I hold our mission at the forefront of my work by recognizing the unique contribution of each one of the individuals we serve. I strive to ensure they are recognized for the person they are and provide opportunities for them that both work towards skills and achievements that are meaningful to them and are fulfilling life experiences. My work with individuals across the lifespan has shaped my perspective when developing programming and delivering behavior support services. Prioritizing the quality of life and having fun are two of our ultimate goals. One of my first discussions with my new team as I was transitioning into this role was about the need to identify indicators of happiness in each of our individuals regardless of skill, ability, or communication modality. It is from there that we can begin to build programs that not only promote skill acquisition or maintenance while minimizing the need for less-desirable behavior but also allow the people we serve to live their most fulfilling lives possible.

Kristy: At the start of every Melmark meeting, staff share ‘mission moments’, in which they reflect on events or client/staff progress that highlight one of Melmark’s core commitments. It is such an inspiring and motivating experience! What is a favorite mission moment you have shared?

Sam C.: I’ve worked with quite a few individuals on improving their oral hygiene as poor oral health can lead to several adverse health consequences later in life. More recently, I have been working with an especially high-risk individual who, at baseline, did not tolerate a toothbrush in his mouth for any duration of time. I developed a procedure to de-sensitize him to the toothbrush and worked with him on a regular basis. Currently, he is tolerating a full two minutes of oral care and will even participate by holding the toothbrush in his mouth. He received a smiley face on his most recent dental report!

Angel: One of my favorite mission moments, which reflects our Evidence-based Practices, was with an individual who was prescribed Lithium for over 40 years with the diagnosis of unspecific mood (affective) disorder. However, the individual didn’t experience any of the signs or symptoms of this disorder. As a result of being on Lithium for a long period of time, this individual developed Chronic Kidney disease Stage 3a, which is renal failure. The medical team at Melmark decided to decrease the Lithium while I monitored any changes in his behavior and mood. The psychiatrist was able to discontinue the Lithium because the individual never experienced any of the signs or symptoms of unspecific mood (affective) disorder during the taper or after the Lithium was discontinued.

Kristy: What are the critical components of working with adults, and how does Melmark address these?

Lindsay: Working in our education department as well as our adult programs is such a unique experience! While the approaches may be a little different, ultimately, we have the same mission and goal. Regardless of age, we want individuals to have full beautiful lives enriched with opportunities to be as independent as possible. In the children’s program, we are very focused on forward progress. In the adult programs, we focus on different intervention priorities such a maintaining the skills our individual possess.

Let me be clear, our adult clients are making forward progress every single day, but I do think we also have to consider the aging process and comorbidities. Many of our adult clients are aging at an accelerated rate compared to their neurotypical peers (such as a decline in physical or cognitive abilities). I think the therapy team at Melmark does an excellent job meeting the adults where they are at and promoting maintenance of current skills. For example, I’m passionate about individuals having the opportunity to eat/drink the least restrictive diet levels for as long as possible. To do this, we have very detailed eating plans with strategies to minimize risk factors of aspiration that are used every single meal. Another example would be an individual participating in a standing program with PT to maintain as much strength as possible.

In the adult program, goals and programs are dependent upon age, ability and helping the individual maintain skills. It’s one of the things I love about the program. We are constantly thinking about not only treatment today but the treatment that may be needed 5+ years from now.

Samantha R.: Working with adult populations poses a unique challenge in how to design and approach both behavior reduction and skill acquisition goals. Skill acquisitions in the adult department have a large focus on building independence with participation in day-to-day activities such as personal hygiene, household activities, and toleration of critical tasks like medical procedures and personal hygiene. Working on these goals requires an approach that utilizes naturalistic reinforcement contingencies to support the acquisition and maintenance of the skill that also adheres to their rights as an adult. Behavior reductions also require careful planning to address the behavior in a way that does not infringe on the individual’s adult rights but still creates meaningful change for that individual to improve their access to the least restricting and most reinforcing environment. Melmark has created a detailed system of checks and balances to ensure adults’ rights are honored while receiving the most effective services to address their needs. Melmark’s Human Rights Committee has both an internal and external review process to ensure the plans and procedures being used with each individual are the least restrictive but still most effective approach to improving that individual’s life.

Kristy: I know that when I transitioned from child to adult services, there were differences that I just was not aware of prior. What is it you would want others to know about in regard to adult services?

Lara: Melmark does a great job at trying to maintain individual’s skills while compassionately navigating limitations they may face to ensure that individuals have access to the skilled professionals that they need throughout their lifetime. We work daily to ensure the individuals continue to live their best life with the resources available. We understand that autism and intellectual disabilities don’t end at 21, and that our individuals spend most of their lives as adults.

Lindsay: Adult individuals need skilled professionals involved in their care when they are 22+. Melmark does an excellent job advocating for funding in these adult programs, providing a model for what investing in these programs can do for individuals. We are promoting the best outcomes each and every day, advocating for adult clients because they are worthy of high-quality services across their lifespan.

Kristy: Thank you all for participating in this interview! We are very grateful that you were able to share your experiences working with Adult Services at Melmark and can see the impact that all of you have on our adult clients.

Citation for this article:

Gasiewski, K., Redcay, L., Duffy, A., Re, S., Chamberlin, S., Cox Crayton, A., & Bly. L. (2024). Voices of those working with adults with ASD: An interview with Melmark clinicians Science in Autism Treatment, 21(6).

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