Behavioral Training Series:



Behavioral Training:

Strategies for Teaching Individuals with Autism Spectrum Disorder

Behavior Solutions, Inc. with support from Autism Speaks is conducting workshops designed to teach parents, caregivers, and others supporting individuals with Autism Spectrum Disorder (ASD), how to teach new skills and decrease behavior problems through the use of behavioral strategies. Following attendance at each of the workshops, attendees will receive on-site/home consultation and training from one of Behavior Solutions’ Master’s level Behavioral Consultants. Throughout the process Behavior Solutions’ staff will conduct an assessment of current behavior problems and functioning and help participants develop and implement a behavior plan.

Goals:

- Teach attendees how to assess and analyze behavior problems

- Provide an understanding of behavioral principles so those supporting individuals with ASD can identify why key skills are not being learned or why behavior problems are occurring

- Teach attendees how to teach new skills through positive behavioral approaches

- Teach attendees strategies to address behavioral difficulties

- Teach attendees strategies for reducing problem behaviors at home and in the community

Services: 10 hours of workshops (split into 2-3 workshops)

10 hours of on-site consultation per participant (scheduled as possible)

Cost Per Workshop Participant: $275

Location: 44 Portwest Ct, St. Charles, MO 63303 (right off Page extension)

Dates and Times:

Round 2: Monday, November 10th 9am-1pm

Monday, November 17th 9am-4pm

Criteria for Participation (eligibility requirements must be met before participation):

- Individuals must have a diagnosis of Autism Spectrum Disorder.

- Commitment from 2-5 support people (parents, teachers, support staff, aides, relatives etc.).

Contact: Angie Peeler, MEd, BCBA

Vice President, Behavior Solutions, Inc.

636-265-0407

apeeler@

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Improving People’s Lives Through

Education, Training and Support

Behavioral Training Application Checklist

Please use the following checklist to ensure you submit all materials necessary for participation in the workshop series. If you have any questions contact our office at 636-265-0407.

Application Items Required

❑ Completed Application form

❑ Eligibility Determination Form (letter from Doctor or Regional Center)

❑ Participant Information

❑ Registration Fees ($275 per participant – Make checks payable to Behavior Solutions, Inc.)

o Registration fees are refundable if cancellation received 1 week in advance of first workshop date. Cancellations within 1 week will be refunded at 80%. Cancellations after start of workshops are non-refundable.

Return entire completed packet to:

Behavior Solutions, Inc

321 Copper Tree Ct.

O’Fallon, MO 63368

(fax)636-265-0407

e-mail: apeeler@

Once application has been processed, and space is available in the training program you will be contacted with dates, times and locations. If the schedule does not work for you registration fees will be refunded at 100%.

Application for Participation in Behavioral Training Series

Individual with Autism Spectrum Disorder Information

| | |

|Name |Diagnosis |

| | |

|Date of Birth |Ph # |

| | |

|Address | |

| | |

|School/Work Name |School/work ph# |

| | |

|Address | |

| | |

| | |

|Guardian’s Name | |

Current behavior problems__________________________________________________

________________________________________________________________________

________________________________________________________________________

Current goals_____________________________________________________________

________________________________________________________________________

________________________________________________________________________

Eligibility Determination Method (only 1 required – see attached forms)

Consent Form Sent to St. Louis Regional Center/DDRB Service Coordinator (

Consent Form and Eligibility Determination Form sent to doctor (

Eligibility Determination Form

***This form should be completed by the parent and sent to their service coordinator at St. Louis Regional Center or DDRB. The service coordinator will send it back to Behavior Solutions.

To: St. Louis Regional Center/DDRB

My child, __________________________________________, receives/is eligible to receive services from the St. Louis Regional Center/DDRB and will receive services from Behavior Solutions, Inc. In order to receive funding from Autism Speaks, Behavior Solutions, Inc needs documentation of my child’s disability.

As a result, I hereby give you permission to send/fax to Behavior Solutions, Inc proof of my child’s disability. Please send /fax one of the following to Behavior Solutions, Inc:

1. A letter of eligibility determination (including diagnosis),

2. The DMH Client Profile form that includes the client number and diagnosis or

3. The CIMOR Diagnostic sheet.

Attn: Service Coordinator:

If mailing: Behavior Solutions Inc. If faxing: 636-265-0407, Attn: Angie

321 Copper Tree Ct.

O’Fallon, MO 63368

Your prompt assistance is greatly appreciated.

Sincerely,

Parent/Guardian signature Date Phone#

Parent/Guardian printed name

Eligibility Determination Form

***This form should be completed by the parent and sent to their doctor. The doctor will send it back to Behavior Solutions.

To: Dr. _______________________,

My child, _____________________________________, will be receiving services from Behavior Solutions, Inc. In order to receive funding from Autism Speaks, Behavior Solutions, Inc. needs documentation of my child’s developmental disability.

As a result, I hereby give you permission to send/fax to Behavior Solutions, Inc. proof of my child’s disability. Please indicate my child’s disability including the applicable diagnostic code. Also, indicate substantial functional limitations in two or more of the following area:

a. self-care

b. receptive and expressive language

c. learning

d. self-direction

e. capacity for independent living or economic self-sufficiency

f. mobility

Please see attached form to be completed by the Doctor.

Your prompt assistance is greatly appreciated.

Sincerely,

________________________________________________________________________

Parent/guardian signature Date Phone #

________________________________________________________________________

Parent/guardian printed name Date Phone #

Eligibility Form: To be completed by Doctor

Date:__________________________

Patient Name:_________________________________ Date of Birth________________

Medical Diagnosis:_________________________________Diagnosis Code__________

Medical Diagnosis:_________________________________Diagnosis Code__________

Medical Diagnosis:_________________________________Diagnosis Code__________

Please describe functional limitations in 2 or more areas:

a. self-care:__________________________________________________________

b. receptive and expressive language:______________________________________

c. learning:__________________________________________________________

d. self-direction:______________________________________________________

e. capacity for independent living:________________________________________

f. mobility___________________________________________________________

________________________________________

Doctor’s printed name

________________________________________

Doctor’s signature

Phone number:________________________________

Please return to:

If mailing: Behavior Solutions, Inc If faxing: 636-265-0407 (Attn: Angie)

321 Copper Tree Ct.

O’Fallon, MO 63368

Participant Information Form

Information of People Supporting individual with ASD who’d like to attend (max of 5)

1.

| |Relationship to individual (parent, support, teacher, etc.) |

|Name | |

| | |

| | |

|Address |Home phone |

| | |

| |Cell/work phone |

| | |

|e-mail |Fax# |

2.

| |Relationship to individual (parent, support, teacher, etc.) |

|Name | |

| | |

| | |

|Address |Home phone |

| | |

| |Cell/work phone |

| | |

|e-mail |Fax# |

3.

| |Relationship to individual (parent, support, teacher, etc.) |

|Name | |

| | |

| | |

|Address |Home phone |

| | |

| |Cell/work phone |

| | |

|e-mail |Fax# |

4.

| |Relationship to individual (parent, support, teacher, etc.) |

|Name | |

| | |

| | |

|Address |Home phone |

| | |

| |Cell/work phone |

| | |

|e-mail |Fax# |

5.

| |Relationship to individual (parent, support, teacher, etc.) |

|Name | |

| | |

| | |

|Address |Home phone |

| | |

| |Cell/work phone |

| | |

|e-mail |Fax# |

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