How to Navigate the Picture Exchange Communication System (PECS®)
February 17, 2023
Encouraging Communication
Picture Exchange Communication System (PECS®) is a form of alternative communication used by individuals who have difficulty with verbal communication. It is a system that uses pictures to help individuals express their needs, wants, and thoughts.
PECS® was developed in the 1980s by Lori Frost and Andrew Bondy, who were working with children with autism (Pyramid Educational Consultants, 2021). The system is based on the idea that individuals who have difficulty with verbal communication can learn to communicate using visual aids. The system uses a series of picture cards that represent objects, actions, and ideas. These cards can be used to create sentences or phrases, which are then used to communicate.
Phases of Pecs
- How to Communicate: The first step includes teaching the individual how to communicate using PECS®. There's usually two people prompting. One person sits behind the individual and teaches them to reach for the card, pick it up, and hand it over to the communicative partner.
- Distance and Persistence : The individual is taught that they can stand, walk over to their communication board, pick up a card, and walk over to their communicative partner. We start initially with very short distances and slowly increase the distance over time.
- Picture Selection : Up until this point there has been one card on the board. Now we teach the individual to discriminate between cards. They will learn to select a card that matches their motivation.
- Creating Sentences : In this phase the individual can select from many different cards, nouns and actions, and we're going to start introducing the I Want card. The individual will learn to place the I Want card on the sentence strip and then for example a picture of a snack. They are creating a sentence with the I Want card and then snack card which reads "I want snack".
- Responding : When someone asks the individual "what would you like" or "what do you want" they will learn to place the I Want card and then tell you what they want. For example a ball or a snack. They would be answering a WH question by adding "I want snack" to the sentence strip.
- Commenting : Instead of only saying "I want", the individual will learn to say "I hear" and then add a picture of a dog if they hear a dog barking, or "I see" and then a picture of clouds if they're seeing that there's a storm coming. This can lead spontaneous communication in which the individual labels stimuli in the environment.
(Pyramid Educational Consultants, 2021)
PECS® is based on the principles of Applied Behavior Analysis (ABA) and emphasizes positive reinforcement to increase the individual's motivation and success in using the system. PECS® has been used successfully with individuals of all ages, including children and adults with autism, developmental delays, and other communication disorders. It can be used in a variety of settings, including schools, homes, and therapy sessions. It is a flexible system that can be tailored to meet the needs of each individual user. Overall, PECS® is a valuable tool for individuals who struggle with verbal communication and can help improve their ability to express their needs and interact with others.
References
Pyramid Educational Consultants. (2021, December 3). Picture Exchange Communication System (PECS)® . Pyramid Educational Consultants. Retrieved March 3, 2023, from https://pecsusa.com/pecs/
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File this one under “Another change to keep up with.” Significant updates are coming to Florida Medicaid, and if you're an ABA provider, you’re probably wondering how this will affect your practice. The Statewide Medicaid Managed Care (SMMC) program is restructuring, reducing Florida’s Medicaid regions from eleven to nine. Click here to read the full details. This change, set to take effect in February 2025, could have significant implications for ABA providers and the families they serve. While the number of Medicaid plans will remain the same, provider contracts, referral networks, and regional structures will be affected. Basically, Senate Bill 1950 has realigned Florida’s counties, with the goal of improving efficiency in service delivery. However, the transition raises questions about potential disruptions in care, administrative burdens, and adjustments providers will need to make. Now, you may be thinking, “Another change? I just got used to the current system!” And if you’re like many ABA providers, you may even be a little uncertain about how this shift will impact your practice. Will this affect service continuity, credentialing, or contracting processes? Here’s the breakdown of what it all means. Need more info, here is the direct link. You Won’t Have to Navigate Eleven Different Regions Anymore The previous Medicaid structure divided Florida into eleven separate regions, each with different health plans and referral networks. The transition to nine regions is intended to simplify service coordination, though it remains to be seen how it will affect access and administrative workload for providers. You’ll Have to Adjust to a New Regional Map The most immediate impact for providers is the need to familiarize themselves with the revised regional boundaries. If your practice operates in multiple regions, your Medicaid billing and authorization processes may require updates.Here’s a map to help you understand the new regional breakdown.
If you’ve been involved in Medicaid provider enrollment for any length of time, you know that policy updates are nothing new. However, that doesn’t make it any easier when major changes—like those in the Florida Medicaid Provider Enrollment Policy —are rolled out. With these new updates, providers now face increased requirements related to eligibility, application procedures, screening, and revalidation. If you’re unsure how these changes will impact you or what you should do next, this post will break it down. Today, we’ll cover what has changed, how these updates may affect your ability to enroll or remain enrolled, and four critical steps you should take now to avoid delays or compliance issues. Let’s take a closer look at these changes. What is the Florida Medicaid Provider Enrollment Update All About? In case you haven't heard, the Florida Medicaid Provider Enrollment Policy, outlined in Rule 59G-1.060, F.A.C., has been updated. These changes introduce new requirements for providers seeking to enroll in or maintain their enrollment in the Medicaid program. The updated policy includes: More Stringent Eligibility Criteria – Providers must meet additional qualifications, including professional licensure, certifications, and stricter compliance with state and federal regulations. Changes to the Application Process – A revised process now requires updated documentation and compliance with new deadlines. Stronger Screening Requirements – Providers may face more comprehensive background checks, additional site visits, and other verification processes depending on their risk category. Mandatory Revalidation – Periodic revalidation is required for continued participation in Medicaid, with specific steps that must be followed. Expanded Provider Responsibilities – Providers must ensure accurate record-keeping, notify Medicaid of any significant practice changes, and adhere to Medicaid billing and compliance policies. How These Changes May Affect You These updates create additional administrative burdens for providers. Some key impacts include: Longer Processing Times – The increased documentation and screening requirements may cause delays in approval for both new applicants and providers undergoing revalidation. Higher Compliance Risks – Failure to meet the new documentation and screening requirements could result in enrollment delays, suspension, or loss of Medicaid eligibility. Increased Scrutiny – The introduction of more frequent site visits and background checks means providers will need to be prepared for unexpected compliance audits. Given these changes, it’s important to take proactive steps to ensure your Medicaid enrollment remains intact. 4 Things You Should Do Now While Medicaid enrollment has never been a simple process, these new updates introduce additional challenges that providers must be prepared for. Here are four key steps to take right away: #1. Review the Updated Policy and Identify What Applies to You One of the biggest mistakes providers make is assuming that previous requirements still apply. The updated policy includes more detailed eligibility criteria and stricter compliance requirements. Take time to review the updated enrollment rules and determine what specific changes apply to your provider type. This includes checking for: New documentation requirements Changes in ownership reporting Additional background screening measures Not staying ahead of these changes could result in delays or disruptions in your Medicaid enrollment status. #2. Ensure Your Documentation is Up-to-Date and Accurate With the increased scrutiny on eligibility and provider compliance, it is critical to ensure all required documents are current. This includes: Licenses and certifications Ownership and control disclosures Background screening records If there are any discrepancies or missing documents in your Medicaid file, this could lead to application denials or delays in revalidation. Avoid last-minute scrambling by reviewing your records now. #3. Prepare for More Frequent Screenings and Compliance Checks Medicaid is increasing its use of background checks, risk assessments, and site visits to verify provider compliance. This means: Providers in high-risk categories may face unannounced site visits. Background screenings will be expanded for individuals with ownership interests in a Medicaid-enrolled entity. Failure to meet compliance expectations during a site visit could result in enrollment suspension. If you have never undergone a Medicaid site visit before, familiarize yourself with what to expect and ensure your practice is prepared for compliance checks. #4. Monitor Deadlines for Revalidation and Policy Changes Medicaid providers are required to revalidate their enrollment at regular intervals. Missing a revalidation deadline can result in termination from the program, requiring a full re-enrollment process. Steps to take now: Confirm your revalidation date and mark it on your calendar. Set reminders for document updates well before the deadline. Regularly check AHCA and Medicaid provider bulletins for policy changes that could impact revalidation. Keeping track of Medicaid enrollment deadlines is crucial—failure to revalidate on time may mean loss of Medicaid payments and provider status. Conclusion Medicaid enrollment is becoming increasingly complex, and these updates only add to the administrative burden for providers. The increased documentation requirements, stricter screening processes, and more frequent compliance checks mean that staying proactive is essential. By taking these four steps now—reviewing the new policy, ensuring documentation accuracy, preparing for site visits, and tracking revalidation deadlines—you can avoid unnecessary delays and disruptions in your Medicaid enrollment. If you have further questions or need assistance navigating the updated Medicaid provider enrollment process, be sure to consult with a healthcare compliance expert or visit AHCA’s website . For more insights on Medicaid enrollment and compliance, check out their training resources. Remember, staying informed and proactive is the best way to ensure continued Medicaid participation while minimizing disruptions to your practice.
For years now, we’ve been hearing that building trust is the best, maybe even the only way, to enhance patient outcomes in behavioral health. I just read another article pushing this same message, emphasizing trust-building as the ultimate solution. And since everyone seems to be saying it, it must be true. Right? Uh... no. I believe most of this advice comes from a place of good intentions. But it's simplistic advice. Not only does a single focus on trust not work for everyone, but putting all your energy into trust-building definitely isn't the most effective option out there. Also, how do you know that the so-called "experts" are following their own advice? Or that they’re actually seeing outstanding results just by focusing on trust-building? You might spend a lot of time feeling frustrated or like a failure because your efforts to build trust aren’t working out. But maybe it’s not you that's the problem! I know because when I was starting in behavioral health, I focused heavily on trust-building strategies, and I didn’t see the results I was expecting. In fact, my experience taught me that trust-building alone wasn’t enough. I felt stuck and inauthentic because the results didn’t align with my core values or patient needs. Here's what I realized: trust-building is important, but it needs to be part of a broader, more holistic approach to patient care. Patients can tell when you're not being genuine or when you're relying on a one-size-fits-all strategy. Always remember: Patients connect with authentic care. Don’t try to force a strategy just because it’s popular. Instead, focus on what truly works for your practice and patients. What’s Not So Great About Focusing Solely on Trust-Building Here’s the thing: Emphasizing only trust-building isn't ideal because: It Wastes Time and Energy : Focusing solely on trust can overlook other critical factors in patient care, such as effective communication, individualized treatment plans, and evidence-based practices. It's Not Always Authentic : Overemphasis on building trust can feel forced, making interactions less genuine and creating distance between you and your patients. It May Produce the Opposite Results : Relying only on trust-building without considering other factors might lead to patient dissatisfaction or disengagement if other needs are unmet. The Approach is Outdated : What worked a few years ago may not be as effective today. The landscape of behavioral health has evolved, particularly with advancements in treatment methodologies and post-COVID shifts in patient expectations and care delivery. Want proof? A study from the American Psychological Association highlights the importance of a balanced approach, where trust-building is integrated with other therapeutic strategies to enhance patient outcomes (APA, 2020). A post on effective behavioral health practices discusses the limitations of trust-building when used in isolation, recommending a more comprehensive approach that includes patient engagement, communication skills, and evidence-based interventions (Behavioral Health Today, 2023). A Better Way to Enhance Patient Outcomes So, how can you enhance patient outcomes effectively? Fortunately, there's a better way. Instead of solely focusing on building trust, adopt a holistic approach that integrates trust with other essential elements of care. Wouldn’t you rather spend your time doing something that not only feels more aligned with your values but also proves to be more effective in improving patient outcomes? Well, now you can. And it doesn’t have to be overwhelming or complicated. A Better Way to Achieve Stronger Patient Outcomes Here’s what I did to enhance patient outcomes without solely relying on trust-building: Step #1: Define Clear Goals I identified my ultimate objectives: to improve patient engagement and satisfaction while also achieving measurable progress in their treatment goals. Defining clear goals is crucial because it gives direction and purpose to your efforts, making them more impactful. Skipping this step can lead to aimless actions that don't produce the desired results. Step #2: Conduct Comprehensive Research I dedicated time to researching different strategies that behavioral health professionals use to improve patient outcomes. I looked for gaps in common practices, analyzed what my colleagues were implementing, and studied both successes and failures. For instance, I found that integrating cognitive-behavioral techniques with trust-building efforts led to better engagement and progress. This insight helped me create a more balanced and effective approach to patient care. Step #3: Develop a Strategic Plan After evaluating what worked and what didn’t, I crafted a more effective way to enhance patient outcomes: Habit #1: Regular Feedback Loops : Implementing regular check-ins and feedback sessions with patients to understand their needs and adjust care plans accordingly. Habit #2: Continuous Training for Staff : Investing in ongoing professional development to ensure my team stayed updated with the latest evidence-based practices. Habit #3: Personalized Care Plans : Tailoring treatment plans to individual patient needs rather than applying a generic trust-building approach. Next Steps To wrap up, I’ve shared why relying solely on trust-building isn't enough and offered a more effective approach to improving patient outcomes. I encourage you to continue exploring innovative ways to enhance your practice. Check out some of my other posts on behavioral health for more insights, tips, and strategies. How to Establish Instructional Control and Motivation in Session The Ultimate Strategy for Building an Effective ABA Staff Development Program Enhancing Organizational Performance Current trends may not always lead you where you want to go. The good news is, you can absolutely achieve better patient outcomes in a way that feels authentic to you. All it takes is the right approach and a bit of independent thinking. If you want more guidance, check out my [course/product/freebie] designed specifically to help behavioral health professionals improve patient outcomes. Click here to learn more and get started today! Questions or comments? Drop them below. I look forward to hearing your thoughts!
Are you ready to start your own ABA company?
Introduction Welcome to the complete beginner’s guide to starting an ethical Applied Behavior Analysis (ABA) company. Today, we're going to tackle the essential aspects of building a company that values ethics above all. You and I know the world of ABA can seem vast and complicated. However, I will make the process of establishing an ethical foundation accessible and doable. By the end of this guide, you will be equipped to set up an ABA company that prioritizes long-term success, staff satisfaction, and client trust, allowing you to make a significant impact responsibly. If you have any questions as you go through it, you can reach me here, and I’ll do my best to assist you. Overview and Definition Time: Ethical ABA Practices Before diving deep, let's clarify what starting an ethical ABA company involves. Ethical ABA practice means more than just following guidelines; it's about integrating integrity, accountability, and respect into every facet of your business. In simple terms, it's about doing the right thing consistently, not only for compliance but for the sake of genuine care. It’s about balancing profitability with a passion for helping people responsibly. 3 Beginner Steps to Ethical ABA Success Step #1: Establish a Clear Mission and Core Values A solid ethical foundation begins with a clear mission statement and core values. Your mission should outline your commitment to providing high-quality, compassionate care. Core values such as integrity, compassion, and respect for clients should guide every decision and interaction within your company. Why this is important: Without a strong ethical foundation, you risk high turnover, client dissatisfaction, and compliance issues. Real-life example: Consider how a mission of "delivering evidence-based, client-centered care" sets the tone for ethical decision-making and client interactions. Step #2: Make Ethics a Top Priority To run an ethical ABA company, enforce a strict code of conduct that aligns with the best practices and ethical standards. This involves transparent operations, ethical billing practices, and a commitment to client privacy and dignity. How to implement: Regularly train your staff on these standards and conduct periodic audits to ensure compliance. Benefit: This not only protects your clients but also builds trust and credibility in the community. Step #3: Invest in Your Staff and Clients Investing in your staff involves hiring qualified professionals who share your ethical values and providing them with competitive pay and opportunities for professional development. Prioritizing your clients means focusing on their specific needs and outcomes, which ensures high-quality care. Action steps: Offer continuous training, fair compensation, and involve families in the care process. Outcome: This leads to lower staff turnover and higher client satisfaction, fostering a positive reputation. Need to build out CEUs for your staff? We can help! Key Takeaways I hope this guide empowers you to start an ethical ABA company that can truly make a difference in the community. Remember, building a business on the principles of ethics and integrity might be challenging, but it is undoubtedly rewarding. Do you want to dive deeper into ethical ABA practices? If you have any questions about this guide or need further assistance, drop me a line here. You can also find me on Instagram . Check out my latest community outreach project for a glimpse of what we do.
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Nervous about starting your own company? There’s a whole lot of confusion on appropriate documentation and Quality Control, which is why it’s easy to feel defeated when you’re doing everything “right” and still worrying about the results. Before I learned how to build templates that met audit standard, I tried every guide and article I could find. Some people would say to go on Facebook groups and ask other people for advice while others felt like putting together documentation templates was easy and there was no need to stress. Many people think that getting advice from social media is the best way to draft their clinical documentation templates because they feel they are not qualified to draft ones themselves. Others maybe so intimidated by the process that they procrastinate, making it harder for them to get started at all. I learned that if you know where to look, you can find everything you need to draft templates that will pass audits. You absolutely should NOT avoid the process because you think you can't get it done! The fear and anxiety related to catching every single thing and insurance may want can be overwhelming. This is compounded by the fact that different insurances have different requirements and these also vary by state. I lived through this fear and anxiety myself when I set out to help people start their ABA companies or assist with quality assurance in existing ABA companies. No matter what I did, I still couldn’t shake the fear that I would miss something and my clients wouldn't pass an audit. Once I finally started consulted with experts and had them review what I drafted I was finally able to come up with a checklist to ensure that I have everything necessary to avoid recoupment. You can do it too! Read on for some sneaky limiting beliefs that may be holding you back from drafting high quality clinical documentation, and how to turn them into your superpowers. Limiting Belief #1: I have to figure this out on my own If you've been burned in the past by people you thought you could trust, or overall are just used to being self-sufficient, reaching out for help can be a taxing experience. Often times it is easier to ask a question in a Facebook group anonymously then contact someone who is considered an expert in the field. Some of you may struggle with asking for help while others may struggle with a fear and anxiety of putting your trust in someone else. How to turn it into your superpower First, challenge your belief. After all, it’s just a belief and you have no proof that it’s reality (spoiler: it’s NOT!) Ask yourself why you think you need to go it alone. Is it that you are embarrassed to admit you need support? Our finances an issue? Once you have the answers, think about what it would be like to do the opposite. What would it be like to have help? Would it make the process easier for you? What it reduce your anxiety? You don’t have to take action now. Just let it sit with you and try to broaden your perspective. Keep challenging yourself. When you’re ready, try reaching out for help. Here are a few resources available: Check out our blog on the importance of Quality Assurance Check out the 3 Pie Squared Podcast Check out this post from Central reach Limiting Belief #2 – I have to build my business first “I’ll draft the clinical documentation once I have a caseload and staff ready to go.” Sound familiar? We all have a list of things we need to do, and in what order we want to do them. But if you’ve been procrastinating on a specific task for weeks or months, it’s probably time to re-prioritize. Do you really need to a fancy website or project management system before you tackle clinical documentation? Or is it that you're putting it off because the mere thought of it seems so daunting? It’s common to put off things we feel we are not ready to do or that we think we are unable to do. But you know what? Having this solid base can help you achieve all those other bigger goals. For example, if you want to build a caseload and hire staff wouldn't it be best to have your clinical documentation ready first? Some insurance is request your templates even if they are for mock clients and staff prior to even granting a provider number. You won't be able to build your caseload if you're not credentialed with certain insurances. How would you hire staff if you don't have clients to give them? How will you train staff in your processes if you don't have templates for them to use? How to turn it into your superpower Act as if your clinical documentation is a road map for your staff. Include things that will help you provide a well-rounded training. Think about a pending audit to obtain a provider number or a future audit after you started billing as an opportunity to receive feedback and improve your processes. Picture it, you're onboarding your first therapist and you go over what their session notes should look like. You explain to them the areas that they need to fill out and the content you want included. This is the first step to ensure that you will pass an audit. Insurance companies want to see proof that you provided therapeutic services that are billable in nature. What about assessment templates? Once you build these out you are able to conduct comprehensive evaluations for clients to best create their treatment plans. This is going to facilitate better client outcomes and help you train therapists on what to do in session with a client. What if you submit your templates and the insurance company says you need to make edits? Then you make the edits. You don't need 100% to pass an insurance audit. If you are at about 80% compliance, typically they will provide you enough feedback and a window of time to make edits to grant you a provider number. As long as you are not engaging in Billing fraud or writing notes that do not showcase therapeutic services you should not be too worried about recruitment. Having lived through a few audits from major insurance companies, if they see any issues with documentation they provide feedback and expect you to make the updates. The important thing to remember is that you need solid clinical documentation templates to set a standard for your staff. If they are not appropriately documenting their services this can become a recoupment issue. Check out our Quality Assurance Services! Limiting Belief #3: I won’t be able to do it Ok, so you know the importance of having solid clinical documentation, but what about the nagging fear of doing this wrong and it all blowing up in your face? You’re not alone. This is another belief that comes from a place of fear, and we all have it. When you’re about to try something new, you picture all the things that can go wrong. The problem with this belief is that it can prevent more empowering beliefs from forming if you’re not aware of them. If fear keeps you from doing things, you may never know what you are truly capable of. You may miss out on amazing life experiences and great success as a result. Don't let fear control you. We discussed the importance of passing audits and avoiding recoupment, but you may still be wondering how you do that. Am I capable of doing that? Will my anxiety let me sleep? The fact that you are worried about doing well is a great indication that you will go to great lengths to meet all the requirements in clinical documentation. How to turn it into your superpower Think of all the clinical documentation you have done in your career. Picture all the good and not so good examples you have seen. I am sure you have enough information to have a general idea of what is necessary. You can absolutely develop well-rounded templates for your company! Remember that providers put out treatment manuals with all the information they require. There are so many insurance specific requirements that it is best to use the most comprehensive requirements as your template. Always over-deliver! For example: I diligently review the Optum Provider Manual, the Tricare Provider Manual and the Florida Medicaid provider manual since these provider have very specific requirements. I listed everything that needed to be included in treatment plans, notes, etc. Then I got to work mapping out what would go into each template. I created all my templates as well as my Client and Employee Handbooks with this information. I thought I couldn’t do it but took the first little step and today everything has changed. I partnered with HR consultants to review my work and so far have a perfect record in passing audits with my clients. We have successfully credentialed multiple companies with the strictest of insurances and they have passed audits with flying colors. Once client asked us to review their existing templates and policies. We worked diligently to suggest edits and they scored a 96% on their audit! Check out our Handbook Templates! Limiting Belief #4: I don’t have time If you believe you have too much work to do already, you’ll find ways to keep yourself occupied with those other activities rather than setting yourself up for success. Saying you don’t have time is really saying I will not prioritize this at the moment. The truth is, if you want to achieve something you have to set goals and do the work. That being said, I am the first one to acknowledge that work-life balance is crucial to good mental health and well-being. We all have responsibilities! Remember that this is a marathon, not a sprint. We have to be realistic with our expectations. As we discussed previously, you do not need to do everything on your own. The key to a successful business is surrounding your self with competent and trustworthy people to whom you can delegate effectively. How to turn it into a superpower You don’t need huge blocks of time to map out your templates. You just have to do it with consistency. Don’t be afraid to schedule uninterrupted time every week to start building everything out. If you can carve out 30 minutes a day, you can start reviewing manuals and listing what you need to add to your clinical documentation. Remember that I already did the work for you and have a good track record on passing audits. Here’s how to get started: Block off time, this will allow you to focus and begin the process. Delegate the task or ask for help if necessary List all requirements you find. Be detailed! Note every assessment mentioned, each timeline presented, and all expectations the insurance provider mentions. Create your templates based on this information. Create specific sections and label them to ensure the document can be easily read. Remember that reviewers may skim the page so you should have all the content easily identifiable. You’re making great progress! It’s time to turn your limiting beliefs into empowering beliefs! If you find yourself procrastinating on getting started, think about what may be holding you back. Write down 10 limiting beliefs, and don’t be afraid to see them on paper. We all have them, remember? It’s what you do with them that counts. Will you push through and keep going? You bet you will! I created all the templates you need to help you get started. Check out our Templates! Remember, you can always reach me here . Let’s get you up and running with your own business!