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Magellan Health Services

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Michael Cameron

on 17 August 2015

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Transcript of Magellan Health Services

Magellan Health Services

Dr. Michael Cameron
Chief Scientific Officer
ObiGobi

August 17, 2015
Evidence-Based Practices
Co-Morbidity
Interdisciplinary Audit Team
The Interdisciplinary Audit Team (IAT) was established for the purpose of providing management and the IAT with reasonable assurance that the clinical management control systems throughout Pacific Child and Family Associates are sufficient and operating effectively. The IAT provides an independent and objective appraisal of clinical operations for management as well as:
Data Analysis
Feedback
Recommendations
Information concerning clinical practices, and related activity
Measures of Anxiety
72%
67%
60%
24%
30%
15%
Autism Spectrum Disorder: Co-Morbidity
68%
64%
Mission
Case Study
Evidence-Based Assessment of Anxiety Disorders
Story to Structure

The Role of Technology
Family Impact
Dyadic Adjustment Scale
Family Adaptability and Cohesion Evaluation Scale
Autism Spectrum Disorder is characterized by varying degrees of impairment in social-emotional reciprocity; deficits in non-verbal communicative behavior used for social interaction; deficits in maintaining and developing relationships; and restrictive and repetitive patterns of behavior, interests, or activities. In addition to these core deficits and features of Autism Spectrum Disorder, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies a range of associated difficulties including:

Preoccupations
Obsessions
Unusual fears

In the professional literature, anxiety among children with ASD is noted with enough frequency that additional diagnoses of certain conditions is required

In a recent study meta-analytic techniques were
used to help clarify the prevalence of anxiety
disorders in the ASD population (van Steensel,
Bogels, & Perrin, 2011). Across 31 studies
examined, involving 2,121 children (<18 years-old)
it was found that:

30%
Had a specific phobia
17%
Had Obsessive-Compulsive Disorder
17%
Had social anxiety disorder (agoraphobia)
15%
Had generalized anxiety disorder
9%
Had separation anxiety disorder
2%
Had a panic disorder
Whether or not co-morbid symptoms of anxiety may
be seen as part of the broader ASD-phenotype, the
presence of a co-morbidity certainly contributes to
functional impairments that reach beyond the core
deficits of Autism Spectrum Disorder. Anxiety impacts:

Anxiety Disorder
Behavioral presentation (e.g, dysregulation)
Cardiovascular system (e.g., heart palpitations, rapid heart rate)
Immune system (e.g., cortisol and a weakened immune system)
Family System
Standard of Care

Following are the six elements from which a standard of
care is derived
State statutes (state mandates for child care professionals)
Licensing Boards'
Regulations
Case law
Consensus of Professionals (and respected minority)
Ethical Codes of
Professional Associations
Consensus in the Community
Physiological Measures of Stress and Anxiety

Cortisol and catecholamines are easily measured in blood, urine, and saliva
Salivary cortisol has become the most popular biomarker used in stress studies (cost is approximately $45.00)
Autonomic Measures

Wearable Health Monitoring Systems
(AiQ Smart Clothing) and Affectiva (Affective Computing Group at the MIT Media Lab)
Parenting stress, salivary biomarkers,
and ambulatory blood pressure in mothers
of children with Autism Spectrum Disorders
Foody, James & Leader, 2014
Salivary alpha-amylase (enzyme)
Behavioral Measures:
Generic and Repertoire-Specific
Clinical Interviews (Anxiety Disorder Interview Schedule)
Self Report Instruments (Beck Anxiety Inventory)
Behavioral Cusp
New Reinforcers
New Contingencies of Reinforcement
New Environments
Generativeness
Competition with aberrant behavior
Impact on stakeholders
Social validity
Multi-Method
Evaluation of Outcomes

Family Based Treatment
Cognitive-Behavioral Treatment
Imaginal Desensitization
In Vivo Desensitization
Filmed Modeling
Live Modeling
Self Instruction Training
Mood Induction
Pharmacology
Coalition of Technological Minds
Behavioral Decision-Making Model

A web-based online interactive decision-making algorithm to help clinicians in their attempts to follow appropriate clinical pathways and standards of care
The software is not a surrogate to a clinician's skills and judgement
Personalized behavioral intervention, clinical analytics, and natural language processing

Access to appropriate assessments
Recommended outcome measures
Review of evidence-based practices (anxiety related to the dentist, MRI)
National Guideline Clearing House
Guideline Title
Bibliographic Source(s)
Guideline Status
Guideline Objectives
Interventions and Practices Considered
Treatment / Management
Major Outcomes Considered
Rating Scheme for the Strength of
Recommendations

Clinical Decision Analysis
Coalition of Technological Minds
Full transcript