Feature Stories

Clinic fills a gap in the Athens community

Nicolas Hicks, age 7, is sitting in a small room in Aderhold Hall on the UGA campus, watching graduate student Anna Bennett theatrically dance around.

"What is she doing?" Emma Barr, the other graduate student in the room, asks.

"Dancing!" Nicolas says.

Bennett pretends to cry.

"What is she doing?" Barr asks.

"Crying!" Nicolas says.

Bennett bounces a ball, knocks on a table, sings a song; each time, Nicolas is prompted to describe what he sees. His parents, Stephen Hicks, a stay-at-home dad, and Bonny Hicks, an accountant in Human Resources at UGA, watch in another room via a mirror that is transparent from their side. Big sister Natalie, 8, giggles when Nicolas makes faces at himself from his side of the mirror.

Nicolas was diagnosed with autism at age 3. At the UGA Applied Behavior Analysis Support Clinic, based in the College of Education, he is learning how to describe others' actions, but also how to transition between activities and spontaneously communicate. These goals and others are written into his Individualized Education Program, a plan required for each child who receives special education services in Georgia public schools. Developed by parents and educators, the IEP addresses a child's abilities and needs and describes how he or she will access the general curriculum.

Nicolas is just one of many who benefits from the UGA clinic, which works with around a dozen cases-usually children, occasionally adults-each semester. Clients may be on the autism spectrum, have other developmental or intellectual disabilities or struggle with maladaptive behavior. Their sessions might be focused on skill acquisition for day-to-day living (anything from communication skills to teeth brushing), or they might target behaviors such as self-injury or aggression to others. Children learning skills typically go to the clinic and receive subsequent home visits for a full semester. Others needing help with behavior usually attend sessions for three to six weeks for assessment, so therapy teams can test different intervention strategies to see what works, train caregivers on how to implement them and check on progress at home periodically.

Clinic Director Kevin Ayres, associate professor in UGA's department of communication sciences and special education, says the clinic was started in 2013 "to fill a gap in the community." At the time, the Athens area had only five Board Certified Behavior Analysts (BCBAs) in the area, and three of them were at UGA (Ayres and two of his students). In fact, Ayres says UGA doctoral students and BCBAs Jen Alexander, Katie Smith and Sally Shepley were instrumental in launching the clinic. Alicia Davis, another BCBA and faculty member in communication sciences and special education, handles intake and is the face of the clinic to many first-time families seeking help.

Such services can cost $100 to $150 a session elsewhere. The UGA clinic is currently free. Even though Ayres notes that eventually there will be some fees required to offset insurance and materials, the clinic will still remain the affordable option for many families, and it prioritizes those most in need. The arrangement benefits both the families served and the UGA students who train there.

"The students working at the clinic are so knowledgeable and truly love working with these clients and their families," says Smith, who-like Alexander and Shepley-previously taught special education in Gwinnett County. "The families have an opportunity to receive services from these students that are all overseen by a BCBA. Even if there were a multitude of BCBAs in the Athens area, it is often difficult to afford weekly services from these individuals."

A five-year, $1.25 million federal grant awarded last November mostly covers the tuition and living expenses of the UGA students working at the clinic, which receives no grant funds itself, Ayres says. The clinic would exist with no federal money at all, but would likely be a smaller operation with fewer students involved. At present, 10 to 15 UGA students work in the clinic any given semester, with those who are BCBAs-mostly doctoral students in special education or school psychology-in supervisory roles.

"We have no reason to think that we will not be able to keep moving forward as we are once the grant funds run out," Ayres says.

The clinic doesn't diagnose nor require formal diagnoses, though some clients already have them.

"We take on kids whose parents communicate that they really need help with the most severe and dangerous behaviors that we are equipped and qualified to help [with]," he says.
Family involvement is crucial, according to Ayres. Clinicians not only work with the children, but also train and coach the parents and caregivers so strategies can be consistent at UGA and at home. Home visits bolster support for the family, as well as target ways to improve the child's environment for success.

"Our approach is looking at environmental causes and those things we can manipulate," Ayres says. "The family is an integral part."

Ann Evans has steadfastly worked with her 8-year-old daughter, Cori, at home, in support of the clinic strategies.

Cori was diagnosed with autism at age 2, communicates using pictures and has some mobility issues. Clinic workers are helping her learn how to walk some distance to reach a "communication partner," so that at home, she can learn to find someone to initiate conversation, rather than needing someone constantly by her side.

A typical clinic session works like this: Cori, sitting at a table, selects an image card to ask for a cracker. The clinic worker moves her chair about a foot away. Cori gets up, takes the card from the table, hands it to the clinic worker and receives the cracker. When Cori returns to the table to get the card to ask for another cracker, the clinic worker scoots her chair a little bit farther away. In this way, Cori is soon walking several feet away from the table to get the cracker.

Cori is also learning to self-calm with music by independently choosing headphones. She also takes walks in the hallway, learning to stop and wait when the adults stop, with the idea that this skill will translate to shopping and other outings where Cori might otherwise wander off.

Before the UGA clinical visits, Cori's behavior was often problematic.

"We tried all the conventional ways to deal with her behavior," says Evans, a registered nurse at the Women's Center of Athens. "Nothing really worked. She scratched, pulled hair and grabbed others. She bites her hand. Things were terrible for us.

No one really wanted to come near her. I begged for a behavior plan from school, but was told that Cori does not really fit the profile. Our house was so full of tension. We stopped going to church, we limited the time that she was out in public, our children stopped having friends over and we stopped visiting family."

Cori's involvement at the UGA clinic, says Evans, has been life changing.

"It wasn't until I started the clinic that I made the connection between her behavior and the lack of communication," she says. "I tried to imagine just one day without communicating. Not just talking, but not writing, not pointing to objects and not pulling pictures. Add to this perhaps not understanding what someone is saying to you, and this person is expecting you to perform. I would be an angry chick as well."

In the months since starting at the clinic, Cori has improved at both school and at home. She has learned to walk and wait on an adult, request items with pictures, imitate simple actions, understand schedules with a picture system and more.

"Overall, Cori is a different child," says Evans. "She is becoming more independent and less aggressive... We take Cori everywhere we go, and she is learning to wait and to continue to use headphones to help. We have made several appearances back in church, and she has been able to sit through an entire service with very few disruptions."

As the clients learn new skills, so do the UGA students who work there.

The weekly opportunities for students to brainstorm interventions and get immediate feedback is "far more than you would get in a typical student teaching or practicum placement," Smith says.
Students at the clinic also have unique access to interacting with clients' families.

"Learning how to interview parents, the importance of interviewing parents, and learning how to work with families and listen to families about what goals are most important to them is a great opportunity," she says.

Barr agrees.

A former behavioral therapist for children with autism at a clinic in Huntsville, Ala., Barr is pursuing a master's degree in educational psychology, with a specialization in applied cognition and development. Her goal is to eventually become a BCBA, and she says getting to know Nicolas' family has been invaluable.

"Nic's family was extremely helpful in walking us through his daily routines, and we worked to incorporate the skills he was learning in the clinic into his home environment," she says. "Being able to engage with Nicolas in his favorite outdoor activities in a more relaxed setting helped us build a great relationship with him, which seemed to carry over to his visits with us in the clinic."
These days, Nicolas follows directions, has become more independent in selecting clothes and food and is working on his reading skills, his parents report. Recently, Nicolas told his teachers, unprompted, that he had eaten tacos for dinner.

"That's what we're excited to see-he's being spontaneous," Stephen Hicks says. "He's understanding more and knows more what's going on. It's hard to quantify that, but you can feel that."

The ability to express his needs more fully has significantly lessened the physical behavior that comes from frustration, he adds.

"It makes his whole world so much better," Hicks says. "When he can express himself, it's huge... It makes all of our lives so much better. He's doing really well."

Ann Evans says the UGA Applied Behavior Analysis Support Clinic has given her the tools she needs to make sure that Cori is successful.

"I love, love, love UGA. The clinic has really changed our lives, and Cori is all the better for it," she says. "This program truly cares about the success of the child. When someone loves your child like that, only positive things can result. Our family is so truly blessed. It is my hope that every child in need of this program would have the opportunity to be served. What a difference it has made in our lives."

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