Testing, Testing....

Will this be the most thrilling blog you read all year? Not by a stretch. I can pretty much guarantee that a blog about TRICARE-required testing is not spellbinding reading. But you can save yourself some stress and confusion by understanding what the testing requirements are, when you are required to complete them, and the best way to approach each one.

There are two basic categories of testing. Testing required yearly and testing required every 6 months.

Let’s break each one down in a little bit more detail.

Vineland Adaptive Behavior Scales (Vineland-3)

• Ages: All

• Format: online questionnaire, child-specific link sent to your email on by “Q-Global”

• Frequency: Yearly, usually due at the time of an assessment (which is why we send the link around the time the BCBA is beginning the 6-month assessment)

• Length: 241 items

• Set aside: at least an hour

• Scored and reported (and feel free to direct questions to): Dr. Kaminski

• Why the results are important: The results from the Vineland are an indication of how well skills and behaviors taught in ABA are being generalized to meaningful activities in the child’s daily life. TRICARE uses this information to evaluate whether skills and behaviors taught during ABA therapy can effectively extend beyond one-one sessions.

• Description: The Vineland Adaptive Behavior Scales (VABS) (Vineland-3) is a standardized assessment tool that measures the child's independent display of skills needed in normal daily living. Adaptive functioning is affected by three basic skill sets, Conceptual (including reading, number, money, time, and communication skills), Social, and Practical Life Skills. Adaptive behaviors include real-life skills such as grooming, getting dressed, avoiding danger, safe food handling, following school rules, managing money, cleaning, and making friends. Adaptive behavior also includes the ability to work, practice social skills, and take personal responsibility. The results can take into account not just age, but also whether the child has ASD, which makes the results more meaningful with respect to level of functioning among children and adolescents with ASD.

Social Responsiveness Scale (SRS-2)

• Ages: 2.5 years to adult

• Format: online questionnaire, child-specific link sent to your email on by “bkaminski@greenboxaba.com”

• Frequency: Yearly, usually due at the time of an assessment (which is why we send the link around the time the BCBA is beginning the 6-month assessment)

• Length: 65 items

• Set aside: 15-20 minutes

• Scored and reported (and feel free to direct questions to): Dr. Kaminski

• Why the results are important: The results from the SRS are an indication of how well skills and behaviors taught in ABA are being generalized to social interactions in the child’s daily life. TRICARE uses this information to evaluate whether skills and behaviors taught during ABA therapy can effectively extend beyond one-one sessions.

• Description: The Social Responsiveness Scale (SRS) identifies social impairment associated with autism spectrum disorders and quantifies its severity. It is one of the most widely used measures related to social impairments associated with ASD. In addition to a Total score reflecting severity of social deficits in the autism spectrum, the SRS-2 generates scores for five Treatment subscales: Social Awareness, Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior.

Pervasive Developmental Disorder Behavior Inventory (PDDBI)

• Ages: 2.0 – 18 y 5m

• Format: online questionnaire, child-specific link sent to your email by “No Reply” (at parinc.com)

• Frequency: Every 6 months, due at the time of an assessment

• Length: 188 items

• Set aside: 30 minutes

• Scored and reported (and feel free to direct questions to): Your BCBA

• Why the results are important: The results from the PDDBI are the primary measure being used by TRICARE to track progress occurring while the child is receiving ABA services. TRICARE requires us to track progress using the scores, explain discrepancies between parents and BCBA scores, and align and modify treatment plans to reflect progress, or lack thereof. It is important, however, to recognize that while TRICARE is using this tool to evaluate the effectiveness of ABA services, 1/3rd of the questions directly relate to speech production (that is, SLP services) and 1/3rd are related to sensory issues (that is, OT services).

• Description: The PDDBI is a rating scale designed to assess problem behaviors, social, language and learning or memory skills of children who have been diagnosed with autism spectrum disorder. Problem behaviors measured via the PDDBI include stereotyped behaviors, fears, aggression, social interaction deficits, and aberrant language associated with children with PDD having lower or high-functioning skills. Questions fall into one of ten “domains:” Approach/Withdrawal Problems, Sensory/Perceptual Approach, Ritualisms/Resistance to Change, Social Pragmatic Problems, Semantic Pragmatic Problems, Arousal Regulation Problems, Specific Fears, Aggressiveness, Receptive/Expressive Social Communication Abilities, Social Approach Behaviors, Expressive Language, Learning, Memory, and Receptive Language. Each item is rated on a Likert scale, from “Never” to “Often/Typically.”

TRICARE also requires one of two parental stress indices every 6 months (depending on the child’s age). These reports are administered by Dr. Kaminski, who briefly reviews the results and, if necessary, helps the Behavior Analyst take into account the reported parental stress level when designing parent and in-home goals. Specific responses to individual questions or within assessed domains are not shared directly with the Behavior Analyst.

Parenting Stress Index (PSI)

• Ages: birth - 12 y

• Format: online questionnaire, child-specific link sent to your email on by “No Reply” (at parinc.com)

• Frequency: Every 6 months, due at the time of an assessment

• Length: 101 items

• Set aside: 20 minutes

• Scored and reported (and feel free to direct questions to): Dr. Kaminski

• Why the results are important: TRICARE requires completion of a stress index (PSI or SIPA) every 6 months. Standardized assessments give families and provider teams clear, consistent measurements over time. TRICARE has selected the PSI because it is a valid and reliable measure of internal stress and dynamics within a family system. The demands of raising or caring for a family member with ASD may increase stress levels. Monitoring the PSI domains can provide useful information for providers and care managers to determine needs for additional support.

• Description: The Parenting Stress Index (PSI) is used to measure the relative stress in the parent-child relationship. Child characteristics in the full scale include: Distractibility/Hyperactivity, Adaptability, Reinforces Parent, Demandingness, Mood, and Acceptability. PSI scores are not used for treatment planning, nor are the scores meant to diagnose dysfunction in the parent/child relationship or as a screening tool for parent mental health. ABA providers can use the PSI scores to identify whether additional family support would be beneficial to increase parent engagement, decrease familial stress and/or support the beneficiary’s access to services. The PSI is also useful in setting priorities for intervention, as some areas of beneficiary programming may address root causes of challenges within the parent/child relationship.

Stress Index for Parents of Adolescents

• Ages: 13 – 19 y

• Format: online questionnaire, child-specific link sent to your email on by “No Reply” (at parinc.com)

• Frequency: Every 6 months, due at the time of an assessment

• Length: 112 items

• Set aside: 20 minutes

• Scored and reported (and feel free to direct questions to): Dr. Kaminski

• Why the results are important: TRICARE requires completion of a stress index (PSI or SIPA) every 6 months. Standardized assessments give families and provider teams clear, consistent measurements over time. TRICARE has selected the SIPA for families with a child aged 13+ because it is a valid and reliable measure of internal stress and dynamics within a family system. The demands of raising or caring for a family member with ASD may increase stress levels. Monitoring the SIPA domains can provide useful information for providers and care managers to determine needs for additional support.

• Description: The Stress Index for Parents of Adolescents (SIPA) is the age extension of the Parenting Stress Index (PSI). The SIPA identifies areas of stress in parent-adolescent interactions, allowing examination of the relationship of parenting stress to adolescent characteristics, parent characteristics, the quality of the adolescent-parent interactions, and stressful life circumstances. SIPA scores are not used for treatment planning, nor are they meant to diagnose dysfunction in the parent adolescent relationship or as a screening tool for parental mental health. ABA providers can use the SIPA scores to identify whether additional family support would be beneficial to increase parent engagement, decrease familial stress and/or support the beneficiary’s access to services. The SIPA is also useful in setting priorities for intervention, as some areas of beneficiary programming may address root causes of challenges with the parent/child relationship.

During each 6-month assessment, the BCBA should be giving you a checklist that includes what testing is required. If you don’t get one, ASK!! You have so much to keep track of and the checklist was designed to help!

Still awake? Congratulations! You made it to the end of the exciting blog about TRICARE testing!