Recruitment News - March/April, 2002

by Kirsta Grapentine

When the State of Michigan overhauled its special needs adoption system nearly a decade ago, they took the bold step of fining contract agencies who failed to meet performance agreements by failing to submit case documentation within six months (182 days) of a child becoming available for adoption. To date, Michigan is the only state to have such a sanction system. Every purchase of service adoption agency lives in fear of receiving a “dreaded” adoption sanction letter. That one page issuance stating that your agency was late in providing documentation showing progress toward adoption to the Michigan Adoption Resource Exchange (MARE). On average, MARE generates four to five sanction letters per month. FIA’s Adoption Division does the actual issuing of a sanction by notifying the payment reconciliation section and the POS adoption agency of the late case. Failure to submit documentation for a case by the 182nd due date results in a twenty (20%) reduction in the contractor’s daily administrative foster care rate for however many days that case is late.

Many agencies are still not clear on when sanctions can be issued, and what cases are “exempt” from a sanction. Let’s look at the latter category first - Cases where sanctions will not be issued for being late are as follows:

Contract cases where the private agency does not have foster care responsibility and is strictly completing the adoption piece or providing residential treatment.
For cases where the first piece of documentation on a case is a goal change (FIA 5s or approved updated service plan). Private agencies have little control over when an FIA worker actually changes a child’s permanency plan, and will therefore not be penalized.
State timeframes for providing documentation to MARE are based on the case permanency date (acceptance date for court wards/ permanent custody date for MCI-state wards). If the permanency date for a case is incorrect, and supporting documentation (pc order, ex-parte order, amended pc order) shows that a case is not overdue, a sanction will not be issued. Always check your monthly MARE tracking list and other documentation requests sent to your agency by MARE; corrections should be made as soon as an error is detected.
Proof that documentation was sent to MARE within the proper timeframes. Although MARE double and triple checks the accuracy of its tracking database, we are not immune to error. Cases may have AKA names, fax machines may be down, computers may be on the fritz -- if you can provide valid proof that your agency provided MARE with documentation for a case within the 182 day timeframe - no sanction will be issued -- or if one was, it will be rescinded. Always keep your MARE generated receipts!

Cases that can and will be sanctioned fall into the following categories:

The case is late. If case is not faxed, emailed, hand-delivered or postmarked to the MARE office by the 182nd due date, it is late and will be sanctioned. In over 90% of all cases, agencies receive three and five month registration notice, as well as monthly notices in the form of a tracking list. Many cases also receive a late case notice from the MARE office once the due date has passed and no documentation has been received.
On rare occasions MARE does not receive data on a child until after the due date for that case. This means the case does not appear on a tracking list, and that registration notices can not be generated in a timely fashion. Agencies should be aware of all cases that are under their care (foster care) and send documentation in a timely fashion regardless of whether they appear on a tracking list or receive notices. Unless supporting documentation is sent to the MARE office showing that the information MARE has on a case is erroneous, the case is sanctioned once documentation is received.
Similarly, if documentation for a case that is not yet in our tracking database and is sent past the due date, the agency will be sanctioned for that case.
Transfer of foster care responsibility. In cases where foster care responsibility for a case is transferred from one private agency to another and documentation is sent to MARE after the due date the sanction will be split between the two agencies. A private agency taking foster care responsibility on a case from either an FIA or private agency, should always note the due date for the case and ask whether documentation has already been sent to MARE. In cases where there is an internal delay in notification from the foster care unit to adoption, the agency is still held accountable.
OTRs (PCA 318/320). When an order placing child is the first piece of case documentation sent to the MARE office, the case can be sanctioned if the difference between the due date and signature date is greater than one day. For example, if a case was due on October 1st and the first piece of documentation received was a pca 320 signed by the judge on October 16th but sent to the MARE office on October 30th, the case would be sanctioned for 15 days.

Although private agencies are rightfully anxious about receiving a sanction on a late case, it should be noted that all sanctions are preventable. Additionally, twenty percent of the daily administrative rate for a purchase of service is usually less than $5 per day, so unless a case is significantly late, the fine is usually fairly small. Some private agencies have taken a proactive stance on avoiding sanctions and have appointed staff to be responsible for making sure that case documentation is sent to the MARE office in a timely manner. Ultimately, the key to avoiding sanctions is good communication between an agency’s foster and adoption units, and an adoption supervisor who is aware of all adoption cases in their agency’s care and makes sure that documentation is sent to the MARE office before the due date.

Living with Oral Apraxia

by Sara Campbell

I am frequently asked about my speech impairment. “Why do you talk so funny?” or “Is there something wrong with you?” are the two most frequently asked questions. Most (if not all) of the people who ask me those questions have likely never heard of Oral Apraxia - the disorder which I have coped with for my entire life. I’m sure that most people reading this article are unfamiliar with Oral Apraxia as well. So when I was asked to write an article for Recruitment News, I asked if I could pick the subject. When the answer was “yes,” I knew exactly what I was going to write the article about. It is my hope to educate people about Oral Apraxia, and to provide information that could help readers notice any signs or symptoms of the disorder in the children with whom they work.

The Diagnostic and Statistical Manual-IV (DSM-IV) does not have Oral Apraxia or Apraxia as part of their lists of diagnoses; however, definitions and other information can be found on various web sites and in other information on the Internet. Nancy R. Kaufman, M.A., CCC/SLP states that “Apraxia of speech (Oral Apraxia) is a motor-speech programming disorder resulting in difficulty coordinating the oral-motor movements necessary to produce and combine speech sounds (phonemes) to form syllables, words, phrases and sentences. Oral-motor weakness may coexist but must not be a primary concern.”1 Kaufman, founder of the Kaufman Children’s Center for Speech, Language, and Sensory Disorders, Inc. (KCC) in West Bloomfield, MI, goes on to list several signs and symptoms for parents and professionals to aid them in the early detection of Oral Apraxia in children. The symptoms can include:

Lack of cooing or babbling as an infant, first words may not appear at all, pointing and “grunting” may be all that is heard,
Delayed first words with many phonemes deleted or replaced with other easier phonemes (basic units of speech,)
Lack of a significant consonant repertoire: child may only be able to use b, m, p, t, d, h,
All phonemes may be imitated well in isolation but any attempts to combine phonemes are unsuccessful,
Words may be simplified by deleting consonants or vowels, and/or replacing difficult phonemes with easier ones,
A syllable is favored, and used for all words,
A word (may be a real word or a nonsensical utterance) is used to convey other words,
Single words may be articulated well, but attempts at further sentence length becomes unintelligible,
Oral scanning or groping may occur with attempts at speaking,
A whole phrase may be clearly said and never heard again, or cannot be imitated,
Other fine-motor problems may be present,
Verbal preservation: getting “stuck” on a previously uttered word, or bringing oral-motor elements from a previous word into the next word uttered.

Observing these signs and symptoms in young children who are learning to talk may indicate that Oral Apraxia is present. Early detection is critical in order to begin treatment which can offer the child the greatest chance for success. While it is important to note that Oral Apraxia is a disorder that can not be “cured,” appropriate treatment significantly increases the likelihood that the child can become an effective oral communicator in the future.

Therapy for Oral Apraxia is strongly encouraged! People with Apraxia may be able to strengthen their speech dramatically, just as I have been able to do after years of therapy. Suzanne Rao, a Speech and Language Pathologist at the ACHIEVE Speech Language & Learning Clinic in British Columbia, Canada offers the following suggestions regarding therapy / treatment for Oral Apraxia:2

Frequency, type, and consistency of intervention are important.
Divide the larger (long-term) goals into smaller (short-term) steps that are concrete and measurable so that a child can see his or her progress along with the caregivers.
Help the child develop a positive self-image about himself/herself as a communicator.
If the apraxia is profound and intelligibility is poor, introduce augmentative communication (sign language, communication boards) as a bridge for oral communication.
Teach pacing, e.g. a slower and more rhythmic rate of speech
Teach early developing and frequently occurring consonants first.
Teach oral motor awareness.
Associate tactile and visual symbols with sounds.
Practice the sounds in the context of frequently occurring words and vocabulary relevant to the child’s daily life.
Multisyllabic words need to be taught, using pacing and tactile cues.

Speech can improve dramatically in children with the help of a good speech therapist who is knowledgeable about oral apraxia. Having the guidance of a qualified speech therapist is one of the best tools with which to address this disorder.

As for my own personal experience with this disorder, it has made me the person that I am today. I have known from the time that I could comprehend that I have this disorder. For nearly eighteen years I have participated in speech therapy in various hospitals, through the public school system, and with therapists in private practice. Oral Apraxia has brought me a great deal of emotional pain throughout my life. I was often teased by my peers from the time I was in the sixth grade until I graduated high school. The pain of not being “popular” or “cool” hurt deeply. I didn’t see myself as “bad” or “strange.” And I did not understand that my peers were simply immature for not trying to understand me and not wanting to know more about Oral Apraxia. Relationships with peers and maintaining self-esteem are significant issues for a child with this disorder. Parents should be aware of this and must find support systems - both professional and on a peer level for a child, with this disorder. It is so important for parents to comfort their child if he or she is having difficulties with peers. Make sure that the child knows that they are loved, respected, and cared for in spite of the disorder, and that they do not have this disorder because they are “bad” or did something wrong.
Oral Apraxia is a disorder, and though it can not be cured, the condition can be significantly improved with a great deal of consistent therapy. While parents should be prepared for the trials ahead, they should also be proud of who their child is. Patience, love, and support are the three things that are needed to raise a child with Oral Apraxia. I’m sure readers of this newsletter have that in their heart already!

Sara Campbell is a student intern at MARE and is also an adoptee. She is completing a Bachelor of Social Work degree at Spring Arbor University in Spring Arbor, MI in May 2002 and is looking for employment!

1 www.kidspeech.com/signs.html
2 www.mankato.msus.edu/dept/comdis/kuster2/therapy/apraxiarx.html

Resources on the World Wide Web: