The Insider: July 2012

THE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERTHE INSIDERVOL. 8 NUMBER 3: July 2012

Summer is HERE!We've got tips to help you survive

My T2K JourneyKimmy Gibson shares her story of

how she came to work at T2Kp. 16

Patient SuccessAna Rothschild shares a patient

success story with usp. 14

Medical MissionAshley Sparkman shares her therapy experiences in Africa

p. 12

Legislative AdvocacyHuman ResourcesChari-T2000

Also: Division Dirt | Family Day | Dugout Day

PLUS:

we'll talk next tiMe...from the administrator, Jerre van den Bent, pT

• Events....................................2

• New Website.......................3

• Dr. Frank McDonald ......4-5

• Vacation Tips ...................6-7

• Dugout/Family Days ......8-9

• Cool Tips ........................... 10

• TAHCH PAC .................... 11

• Medical Mission ......... 12-13

• Patient Success .......... 14-15

• Employee Story ......... 16-17

• Summer Tips ............... 18-19

• Chari-T2000 ..................... 20

• Vacation or Bust? ............ 21

• G-Free ............................... 22

• Division Dirt .............. 23-28

Inside This Issue:

WHERE T2K'S BEEN

Left: Staff in San Antonio attended an event at the Autism Resource Center. The keynote speaker was an attorney who uses an assistive technology device to communicate.

Right: THERAPY 2000 conducts an in-service for foster care case managers in San Antonio.

WHERE T2K WILL BE

THERAPY 2000 VOLUNTEERS AT THE KIDNETIC GAMES

Central Division

E.Y.E. Can Swim ............................................................................................. July19th and 20th

Texas Baptist Home Resource Fair ............................... September 8th — 9am to noon

West DivisionTarrant County Back 2 School Roundup ...................................August 8th — 8am-2pm

Jerre had to take an unexpected leave of absence. He will return in the next Insider.

editorial staff

Jerre van den Bent, PTEDITOR-IN-CHIEF

Kyle ButlerMANAGING EDITOR

Alex ParisCOPY-WRITER/EDITOR

Jennifer RileyLEGISLATIVE ADVOCACY

Belinda Williams, OTREDUCATION

Ira KirkleyHUMAN RESOURCES

Maicol NietoDESIGN CONSULTANT

from the administrator, Jerre van den Bent, pT

WHERE T2K'S BEEN

WHERE T2K WILL BE

(SAME ADDRESS , WHOLE NEW LOOK)

Our website is up! Stop by for a tour and to see our new, improved re-design! Now it's easier to navigate and still has T2K mail and Mangrove links (employee login) in addition to lots of new fun features. Browse our “slider” on the homepage to see our front page news. Click through to see all our new, beautiful photography. Be sure to visit our newsroom blog full of up-to-date content, and faces you know. Got something you think would be a good fi t for the newsroom? Contact [email protected] with the details.

therapy 2000 unveils its new weBsite

The red box above shows the location of the link to access T2K webmail.

The red box above shows the location of the link to access the employee portal to Mangrove.

Frank E. McDonald, M.D.Board Certified, American Board of Pediatrics Board Certified, American Board of Physical Medicine and RehabilitationBoard Certified, Pediatric Rehab MedicineMedical Degree: St. Louis University School of Medicine, St. Louis, Missouri, 1969Internship: Cardinal Glennon Children's Hospital, St. Louis, Missouri, 1970Residency (Pediatrics): Cardinal Glennon

Children's Hospital, St. Louis, Missouri, 1972Residency (PM&R): University of Texas Health Science Center, San Antonio, Texas, 1992Interests: Pediatric Physiatry, Inpatient Acute Rehab and Outpatient RehabilitationOffices: Our Children's House at Baylor, Children's Medical Center

Dr. Frank McDonald is very well-known in Texas and nationally in the medical field of physiatry, otherwise known as physical medicine and rehabilitation (PM&R). He has been practicing in Dallas since 1992 and specializes in treating children with physical, cognitive, and/or language disabilities, helping children to reach their full potential and improve their quality of life. He is board certified in Pediatrics, Physical Medicine and Rehabilitation and Pediatric Rehab Medicine. At this time less than 2oo doctors in America are Board Certified in Pediatric Rehab Medicine. In 1992, he helped start Our Children’s House at Baylor. He also heads up the Pediatric Rehab Medicine Department at Children’s Medical Center. Since April '07 he has been practicing at both Our Children’s House at Baylor and Children’s. THERAPY 2000 is honored to have Dr. McDonald serve as our Medical Director. Jennifer Riley sat down with him in June to learn a little more about his specialty and discuss the importance that all types of therapy play in the role to recovery.

Riley: Tell us about your background.

Dr. Frank McDonald: I attended medical school in St. Louis and did a pediatric residency there from 1969-1972. Then I went back to where I was born, McAllen, Texas and practiced general pediatrics for seventeen years. It was during this time I become interested in children with special needs. While I was there I was able to start several sub-specialty clinics including a Muscular Dystrophy Clinic, a Rheumatology Clinic, a weekly Hematology Oncology Clinic, a Pulmonary Clinic, and eventually an Endocrine Clinic and an AIDS Clinic. I become much more interested in team care. I was asked to head up a rehab hospital so I arranged for second residency in Physical Medicine and Rehab at UT, San Antonio from 1989-1992. So I got double boarded.

Since 1992, I’ve been in Dallas. I started with Our Children’s House [at Baylor] and worked there; we built it from a vacant lot to what it is now. In 2006 they asked

me to head up a Baclofen Pump Program at Children’s. After a few months, they asked me to head up their new Pediatric Rehab Medicine Department. Since April of '07, I’ve worked halftime at Baylor and halftime at Children’s. My job here at Children’s is Director of Pediatric Rehab. In 2009 we developed a Pediatric Rehab Fellowship so we can qualify these fellows for sub-specialty certification in Pediatric Rehab Medicine. So far, we have two graduates and one halfway through the program. I decided since my re-certification in Rehab was due in 2014 that I ought to just go ahead and get my boards instead in Pediatric Rehab Medicine, so I did that in November '11.

Riley: As a pediatric PM & R Doctor can you share your point of view on the importance that routine therapy (all types) plays with patients?

Dr. Frank McDonald: The basis, the foundation, for rehab medicine is therapy. Whether you are an inpatient or outpatient, therapy is key to getting rehabbed. Our job as Pedi Rehab Medicine doctors is to see how appropriate and ready the patients are for rehab programs that they have to go through. PT, OT, speech, music, there are all kinds of therapy programs. We work with coordinators and social workers to get that set up. We also have to decide how much are they ready for.We have to advance the therapies as appropriate, some kids just can’t do a whole lot early on.

Riley: How important of a role do the parents play in their child’s therapy?

Dr. Frank McDonald: Major. The real advantage of pedi rehab is that most of the time they have people who can be trained in what to do when therapist and doctors aren’t there. They have 24/7 caregivers. One of the major things we do in pediatric rehab is train parents on what to do. You have to be able to get them bought in on what needs to be done first, because a lot of times they go home and don’t do it. They think, “The therapist is coming in 1, 2, and 3 days a week so why should I have to do anything?” When in reality the therapist should serve as a teacher and teach them what to do every day. That’s one of my strongest feelings about what therapy does for us…and that’s train the caregivers on what to do. They can answer the parents’ questions.

Riley: I know that at Children’s there is a huge importance placed on the team approach. What role have you played in that team approach and involving parents?

Dr. Frank McDonald: I first learned about teams in one of my sub-specialty clinics in McAllen, Texas when I was a

therapy in the role to recovery frank Mcdonald, M.d.

pediatrician. We had a rheumatologist who came down to see these patients once a month with a team that usually included an OT, PT, a social worker, resident and sometimes a nurse. Then we’d see the patients. At the end of the morning we would sit down at a table and everybody would discuss the patients that we had seen, what goals we had for them, what kind of therapy they needed, what kind of equipment they needed, and what kind of social help they needed, etc. I sat there, just amazed, sitting at a table with a bunch of people who each in their own right was an expert in what they did. Being able to pick all their brains in one spot, about one patient, and come up with answers; I just fell in love with the team approach with that. I’d been a pediatrician on my own for a long time so this concept was really, really new to me. The other thing that was really coming into vogue at the time in the eighties was the family-centeredness approach. I think getting together a team of therapists who all would be people who interacted with the family was really important, that really brought it home.

Riley: What we see at THERAPY 2000 is that the payers, regardless of commercial insurance or Medicaid, really want the physician to sign off on everything. Most of the physicians that we talk to say, “I believe in the recommendations of this licensed clinician.” We do have some doctor’s wanting to decrease or increase frequency but for the most part there’s that professional and clinical respect. Where do you think the relationship between doctors and therapist is heading?

Dr. Frank McDonald: Unfortunately, it’s going to be heading wherever the government and the insurance companies want it to go. That’s the way I see it. There are a lot kids who need various kinds of therapy, whether it’s an inpatient clinic, outpatient clinic, or home therapy that’s best for them. Having a therapist in a home environment is often times more practical. Especially, where transportation is a major problem. The advantage of an outpatient clinic is that it has equipment a therapist can’t bring with them. So inpatient, outpatient or home therapy is something we have to think about. What kind of equipment they need, what kind of teaching they need, what kind of help. We have to take all of that into consideration when making our decisions. Then we try to recommend the most appropriate therapy.

Riley: In this edition of The Insider, we are focusing on summer and everything that comes along with it; including school being out and lack of routine. What advice would you give families on how to handle the change of routine?

Dr. Frank McDonald: They should think about what are they going to do with the kids during the day. It’s an opportunity for parent’s to emphasize more therapy goals

and pay more attention to what the therapist wants them to do at home. When I talk to a parent and say this child needs this therapy twice a day, one of things I have to realize is: How are they going to do therapy when they are getting their whole families ready for school in the morning? I’ve been a parent; I remember how hard it is just trying to get a kid ready for school. We have to give a little in those circumstances. In the summer we have more time to pay attention to therapy. It’s especially important not to stop therapy all together. A lot of times families stop in the summer and then have to start again from scratch in the fall. They forget a lot of things from school and therapy. It’s a real opportunity for home therapy to get involved and really prime them for back to school.

Riley: What advice would you give families putting together summer vacation plans with a child with disabilities?

Dr. Frank McDonald: It’s depends on the acuity of the child. Is the child totally dependent or moderately independent? One of things I always tell parents is to make sure you have all your family’s medicines; you do not want to have to get something filled at a strange pharmacy. I also think sometimes it is good for kids to get away from therapy once in a while because, unfortunately, they can’t really get a vacation from the meds most of the time. Good planning is important. You just have to assume that someone will get sick or have some sort of problem so you have to be ready for it, all contingencies.

Riley: So you think it’s ok for kids to miss therapy and doctors’ visits for a vacation?

Dr. Frank McDonald: Yes, especially if the parents are well-trained on what to do. It goes back to family therapy and family training on what they should be doing everyday, anyway, in a home setting.

Riley: Anything else you would like to add?

Dr. Frank McDonald: I think, especially now, that insurance companies are less likely to allow children to get the in-patient therapy that they need, the family training it is really going to be much more important, outpatient and in-home therapy will have to pick up the slack. There are some managed Medicaid and insurance companies that just right off the bat say, “Well, no. That child is not going to qualify even if it’s needed. You can take them but we aren’t going to pay for it.” The trouble is, home therapy and outpatient therapy are having almost as much trouble getting paid as inpatient therapy. Since these patients are being sent home with people who aren’t trained or only half trained then home therapy is really going to have to pick up the slack.

Theresa and Tommy have two adorable sons named Thomas (age 6) and Tim (age 5). Their youngest son Tim has Down syndrome and currently receives PT and ST from THERAPY 2000. Almost every summer they travel 1,800 miles by plane to visit family in the northern California area. Their kids

have been lucky enough to see some of the beauty of other parts of America; including the vast Pacific Ocean, the Golden Gate Bridge and the redwoods of northern California.

Everyone knows travelling with kids long distances can be a challenge. This family goes ahead and braves the challenges to never miss an opportunity to expand the boys’ horizons. A long plane ride with two kids might seem daunting to any mom, but Theresa is a seasoned pro and knows a little preparation can go a long way. Theresa was kind enough to take time out of her busy day caring for her two kids this summer to share with us some of her best tips on travelling with special needs kids.

• USE A COUPLE OF DAYS JUST TO CHILL OUT FIRST. If you are travelling a long distance and your final destination involves staying with family or friends, rest up before you get there. All the packing and travelling at the start of a trip can be taxing on the family. Theresa and her family like to check into a hotel for a couple of nights before hitting their extended family’s house. Theresa shared, “We unwind, hit the hotel pool, and just chill for 24- 36 hours before arriving at our family’s house. “ That way they arrive at their final destination nice and well-rested and ready for fun.

• TAKE LOTS OF PICTURES. You may only be gone a couple of weeks but the pictures you take last forever. Theresa takes tons and puts them in an album when they get home for the kids to relive the memories all year. Don’t forget to bring your camera charger!

• PLAN AHEAD. Do your research. Plan ahead and see what’s around the area that is age-appropriate, free and/or inexpensive and happening during the time of your visit. You might even find tickets to local events at a discount if you plan ahead. Research early on ensures

everyone gets to do something they like and makes the whole trip more efficient and enjoyable. Don’t forget to check out local resources for special needs kids to get even more tips for successful travelling.

• ALWAYS CHECK YOUR GATE BEFORE YOU LEAVE HOME. There is nothing worse than schlepping yourself and bags across an international airport because your flight’s gate has been changed at the last minute. Add kids, car seats, and baggage and you could very well miss your flight. Often it takes 30 minutes or more to get across an airport. It’s chaotic, stressful and not a good way to start a vacation. In Theresa’s case, in one of these mad dashes to get to another terminal on time,

her oldest son Thomas stepped off the terminal train at the wrong stop. Due to the sardine-like circumstance of the packed vehicle he almost missed getting back on. He made it but this leads us to her next great tip…

• CREATE ID TAGS FOR YOUR CHILDREN. Theresa creates up-to-date identity tags for both her kids before travelling. That way, if something were to happen in a busy airport, like an accidental separation, authorities would be able to identify the children and get them back safely to their parents. When Theresa first started travelling with her younger son Tim, who has Down syndrome, his vocabulary was very limited. So this tag was very important. She trained Tim to find someone in uniform and show him/her his ID tag. Tim's tag is visibly attached on the back of his shirt. At this point the authorities could call the parents and tell them that their child is safe.

• RESEARCH YOUR AIRLINE! Look into the airlines you might be flying when researching tickets and check out their amenities. For example, Virgin America has an in-flight entertainment system with free video games, movies, music and live TV. Did we mention video games? This keeps the kids occupied for hours and lets parents lug less “entertainment” along. When they flew Virgin America both kids got to hang out in the cockpit while the passengers were loading and get their pictures taken. You don’t see that happen too much anymore!

safe summer travels for kids with special needs

Tim on beach in Pacifica, CA

Thomas on beach in Pacifica, CA

Tommy with his boys, Thomas & Tim, and grand-mother, Freda, walking along beach in Pacifica, CA

I am Thomas Lastname. Travelling on Sat. Aug. 11, 2012 from DFW to SFOVirgin America Flt. #123, departs @ 7:05 a.m. CST

Arrives SFO @ 9:30 a.m. PST. Travelling with my mom-Theresa , dad-Tommy, and little brother-Tim. Tim has Down syndrome.

Emergency contacts. All are cell phone numbers.Mom 555-925-5555; Dad 555-925-6666 or in Calif. call Uncle Larry 555-768-5432, Aunt Louise 555-768-4321

• BE PREPARED. Be sure to bring lots of gum and gummies and a bottle if it’s age appropriate, so your child's ears don’t hurt when taking off and landing. Theresa also like to bring sippy cups with a straw since the drinks you get on a plane come in a wide cup and are prone to spilling. Healthy snacks that don’t spoil also go a long way and come in handy on the plane or if your fl ight happens to be delayed. Think apples, string cheese, summer sausage and snack mixes. Theresa like to store customized snack mixes (every kid gets to pick their favorite combo) in old plastic peanut butter jars. That way they don’t get smashed in commute and don’t melt like they would in a plastic bag.

• PACK MEDICATION AND MOTION SICKNESS MEDICINE IN YOUR CARRY-ON. Don’t get left in a lurch if your bags don’t show up where you are. Keep everything you must have in your carry-on.

• PACK AN INFLATABLE BEACH BALL. This one is genius. It is light and folds up nicely when not in use and most importantly, it can entertain the kids waiting in an airport for at least an hour!

• FREE ACCESS TO NATIONAL PARKS. All U.S. citizens or permanent residents with permanent disabilities have free access to national parks.

• HAVE FUN! A CHANGE OF SCENERY IS GREAT FOR EVERYBODY!

Theresa shared with us a sample of the cards she would print out, glue onto a 3x5 card and laminate before a trip. On the day of the trip she uses a safety pin to attach them to Thomas' front pocket and on Tim's back. Each kid has one card. She carries the cards that have the information for the return trip with her in her luggage and uses them for the return trip.

Theresa, Freda and boys at Humboldt Bay in Eureka, CA - the monument to honor fishermen lost at sea

San Francisco International Airport, waiting for dad to come back from returning the rental car

Theresa, Thomas & Tim withGrandma, dwarfed by Redwoods

I am Thomas Lastname. Travelling on Sat. Aug. 11, 2012 from DFW to SFOVirgin America Flt. #123, departs @ 7:05 a.m. CST

Arrives SFO @ 9:30 a.m. PST. Travelling with my mom-Theresa , dad-Tommy, and little brother-Tim. Tim has Down syndrome.

Emergency contacts. All are cell phone numbers.Mom 555-925-5555; Dad 555-925-6666 or in Calif. call Uncle Larry 555-768-5432, Aunt Louise 555-768-4321

children's travel info tags

Personal info for Tim Lastname

Born @ 38 weeks gestation, normal delivery. Down syndrome.Speech is delayed. Knows many signs. Un-derstand 90%+ of what is spoken around him. Cannot swim. Working on potty training. Not yet initiating

using restroom on his own. Uses fork & spoon to eat, straw in cup with lid to drink. Daily med. for

hypothyroidism, 75 mcg of xyz medicine. Allergic to amoxicillin -causes rash on body.

Sample Front Sample Back

The hot June sun could not stop T2Kers from coming out to the Dr. Pepper Ballpark to see the RoughRiders play the Corpus Christi Hooks on Saturday evening.

Everyone represented in their jersey-like t-shirts, which made it

easy for us to stand out in the crowd!

The game was super fun with entertainment from Daisy and Deuce; who supplied plenty of hijinks such as dancing, t-shirts tosses and water gun fi ghts with the umpire!

Just like at the offi ce, there was no shortage of food. The Grab and Go section provided us with an ample offering of nachos, hot dogs, sausages and sodas! Yummy! There was even an eating contest on the fi eld! Maybe we could do one here at corporate? Any takers?

THERAPY 2000 had prime seating, fi lled with plenty of action! There were several fl y balls that came our way! One of our own even caught one! Congratulations!!

All in all the night was a huge success and everyone had a great time! It was so fun to see our T2K family out there having a good time and rooting for the home team!

dugout day! faMily day!

dugout day! faMily day!THERAPY 2000 employees had a great time at Family Day 2012 held at Amazing Jakes. There were video games, go karts, a climbing wall and

entertainment galore! Big and small, fun was had by all! Many thanks to the social committee for putting together such a great event!

cool tips BElInda WIllIaMS, oTr, EXECUTIVE dIrECTor of EdUCaTIon & Qa

As summer continues and the temperature rises, there is no need to lose your cool. Try these tips for summer comfort!

DO1. DO keep a well-insulated cooler or ice chest in your trunk.

Store several wet wash cloths each secured in a zippered sandwich bag, several very damp bandanas (all in one zip lock bag), wet terry cloth like wrist bands, frozen water bottles & sports drinks, chilled apple slices and frozen grapes.

2. DO apply cold compress (wash cloths) to neck and cold wet wrist bands to pulse points between visits. Place bagged cold wet wash cloths in under arm areas or at breast bone between visits.

3. DO use the cold damp bandanas as a cooling head band and rotate back to cooler for a fresh one at end of each visit.

4. DO drink ice cold water bottles and sports drinks as they melt, these will help to lower your core body temperature. Snacking on frozen grapes and chilled apple slices will also help, not to mention keep you from running through the golden arches.

5. DO add mint leaves or frozen berries to your water. It cools down your water and keeps your taste buds interested. Try to drink one 8oz glass of water for every 20 minutes of sun exposure to stay hydrated.

6. DO slather on sunscreen; skin cancer research shown that more than half of the melanoma and merkel cell carcinomas were on the left side of the body – from driving. So put on a shot glass full (the recommended amount from skincancer.org) every day.

7. DO wear your hair in a style that tolerates dampness. Keep a spray bottle with a couple of drops of a favorite essential oil or extract for refreshing fragrance to rewet your hair, especially near the scalp, throughout the day.

8. DO eat several small meals instead of 1 or 2 large ones which increase core body temperature.

9. DO get spicy! People of Mexico and India might be able to attest that eating hot stuff can cool you down. The capsaicin in chili peppers helps you perspire. When the sweat evaporates, you cool down!

10. DO mist your face, arms and lower legs with 1:1 alcohol/water spritz, which will evaporate quickly and help to cool you.

11. DO keep your car as cool as possible; park in shade if available, use window shades in front and back windows, crack the windows slightly if safe to do so, and use a cloth seat cover over leather seats if you have them. Cover steering wheel with a fitted cloth cover or cover with a towel between visits

to avoid handling a hot steering wheel and therefore increasing body temperature.

12. DO find out if your medications make you susceptible to dehydration or sunburn. Many meds like antibiotics and diuretics can block the body’s natural ability to handle the sun and heat. Ask your doctor, pharmacist or nurse if you need to take any extra precautions this summer.

13. DO respectfully work with the family to keep cool in the home; if air conditioning is not available, try to make that visit before 10am, or place frozen water bottles in a metal container and place between you and a fan for a cool breeze.

14. DO wear light weight, loose clothing w/ a loose weave, such as cotton, linen or a perspiration wicking material. How about some fabulous T2K scrubs?

DON'T1. DON'T layer clothing, or wear synthetic fabrics. That includes

underwear.2. DON'T eat heavy meals.3. DON'T react emotionally to traffic or other frustrations

especially when you are in the heat.4. DON'T fail to take breaks as needed; plan regular stops at

your favorite oasis; i.e. Starbucks, library, restaurants, etc.5. DON'T ignore early signs of heat stroke; fatigue, weakness,

nausea/vomiting, light headedness, and/or muscle cramps. Instead seek immediate hydration and cooling at first sign and when in doubt call 911.

6. DON'T focus on the heat; instead imagine yourself floating in the cool waters of your favorite pool or a mountain lake.

7. DON'T drink hot beverages, they will further raise your body temperature. Caffeine will also cause some people to have surges in body temp.

8. DON'T wear socks with enclosed leather shoes. Opt for more open meshed shoes or clogs and light anklets or no socks.

9. DON'T drink sugary beverages, as they can contribute to dehydration.

10. DON'T forget that our dress code allows for knee length shorts or capri type pants during warm weather, but open toed shoes and tank tops are not allowed.

Remember that we always appreciate your dedication, but

especially this time of year! Please take good care of yourselves!10

11

why i give to the tahch pac JEnnIfEr rIlEy, Cr dIrECTor

Our home care association, Texas Association for Home Care and Hospice (TAHCH), has strong ties on both the state and federal level. These ties have helped our industry—the children we serve AND our jobs—time and time again. These ties are strengthened

through grassroots involvement, relationships with elected offi cials and campaign contributions.

After my fi rst full year of giving to the TAHCH PAC, I was invited by TAHCH to attend a series of campaign fundraisers on the weekend known as Texas/OU. Vanessa Richardson and I represented THERAPY 2000. We went from fundraiser to fundraiser with TAHCH staff and TAHCH lobbyist, Bill Pewitt. I remember how exciting it was for Bill to reach into his pocket and present a key legislator with a campaign contribution. To this day, I recall Bill whispering in our ears the critical battles certain legislators had fought and won for our industry. Several legislators stuck out that weekend: Senator Royce West, Representative John Zerwas and Chairman Jim Pitts—all of whom received checks from our PAC.

Senator Royce West represents the district where THERAPY 2000 began and Lone Star is still in. He serves on the Senate Finance Committee and the Senate Health and Human Services Committee. Both of these committees play a key role in the budget for our services and policy and regulation surrounding our industry. He is a supporter not only of home care but of THERAPY 2000. He appreciates the children we serve in his district and the adults we employ. He is a fan of Jerre, and we are fans of Senator West! Oak Cliff, South Dallas and the state of Texas need Senator West, and my PAC contributions help keep him in offi ce!

Representative Zerwas is a physician from the Houston area, and he played a direct role in saving our industry during the last legislative session. He serves on the House Appropriations Committee as Chair of the Health and Human Services Subcommittee, also known as Article II of the state budget. Dr. Zerwas also serves on the Conference Committee for Senate Bill I, the state budget for the biennium, and the Public Health Committee and Calendars Committee. All of these committees make decisions that play a huge role in our industry. Dr. Zerwas has repeatedly “gone out on a limb” to defend the services we provide. He believes that services provided in the home are a cost

containment strategy for the Texas Medicaid budget, and he believes that the services we provide are creating a better future for Texas. I am honored to have spent much time with Dr. Zerwas, and I cannot think of a better friend to our industry. I cannot wait to see him re-elected with the help of my contributions to our PAC!

Chairman Jim Pitts is from Waxahachie and serves as Chairman of the House Appropriations Committee. As chairman of this committee, he is responsible for making the recommendation to the House as to where the money should be budgeted every legislative session. He is a good friend of Dr. Zerwas, and he relies on Dr. Zerwas to make decisions based on the state’s Health and Human Services budget. Along with Dr. Zerwas, he is a supporter of our industry. After the last state budget bill passed, there was a question whether our services were subject to a rate decrease. Chairman Pitts and his staff are directly responsible for making it clear to the Health and Human Services Commission that the legislature did not intend to impose any cuts on services provided in the home to children. I have had the pleasure of meeting with Chairman Pitts on multiple occasions, and I recently campaigned for his re-election. Along with Dr. Zerwas, Chairman Pitts is the most infl uential legislator for our industry. Helping Chairman Pitts, Dr. Zerwas and Senator West stay in offi ce, is the reason why I give to the Texas Home Care and Hospice PAC!

Many of you have asked what impact the recent Supreme Court of the United States ruling on the Affordable Care Act has on our industry. It is not completely certain at this time. What we do know is that the state budget is tight. We also know that not all legislators are supporters of our industry. Please consider monthly contributions to the Texas Home Care and Hospice PAC to help preserve our industry—the children we serve and our jobs! To get started, email [email protected] for a contribution form.

TAHCH Lobbyist Bill Pewitt with T2K’s Vanessa Richardson and Jennifer Riley presenting PAC check to Senator Royce West at Texas/OU Fundraiser several years ago.

Medical Mission in africa By aShlEy SparkMan, pT

Waking up to "home health" in West Africa is a little different than what we experience on a daily basis here. Well, maybe it's a lot different, but that's just the en-vironment. When

you strip it down to the basics, it's still what we all love — watching people gain the independence that they and their families have longed for.

The quarter mile walk to "Allie's" house is nice with kids and women greeting me each block I pass. Sure it's hot, as is ALL of Sub-Saharan Africa, but the lack of humidity makes it bearable. I'm praying for my day as I go, and for the people around me, that I'll have wisdom in decision making in a place where there is no doctor, and that they'll see God's love demonstrated in my actions. My flip flops are full of sand, but I've grown to love the dusty feeling on my feet in the three months I've been walking this road. As I turn to enter the gate that opens up into Allie's yard, I greet her husband, and announce my entrance, as is customary. Allie smiles up at me from her old mat on the

ground. She tells me about what's been happening in the few days I was visiting another village while offering me the food they were cooking.

Her house is small with two rooms for three adults and countless children. They cook and use the restroom out-side and have a small area for their four goats and sheep in the corner. I ask her how her body is (one of the custom-ary greetings) and she responds "it's better." They always say it's better. Even if they're dying, they'll tell you that it's better. I don't know what happened to Allie, but when I met her, people had to assist her to the house I was

staying in. She couldn't walk more than a few feet with crutches and assistance and she had to crawl over the threshold into her room. From all that I could gather, she had some type of cyst or infection in her thoracic spine eight months previously. They had no name or descrip-tion for it and weren't even able to tell me what the prob-lem was, except that her legs were sick and she couldn't walk. From my evaluation it became clear that some inju-ry had happened in her thoracic spine, although there was no reported accident or trauma. Her abdominal muscles and her legs were terribly weak, to the point that it was a task to get sitting up on the edge of her small bed. But that was the first week. After three months of working

Thank you Ashley for demonstrating T2K's core value: We Give Back

12

hard and gaining strength, she was standing up and walking eight feet across her room without assistance and walking in her sandy yard with only two canes. She no longer has to crawl anywhere and has been able to resume some of her previous activity.

When the time drew near for me to return home, she repeated over and over "it's not good" and tried to per-suade me to marry a local man so I could stay. After all, my brother was getting married soon, so my mother would have a new daughter and not miss me, right? Despite their pleas, my time soon came to an end, and with sad-ness I left a people who had won my heart and become my friends, as I sought to love them and bring hope to the hopelessness they speak of, through sharing God's love and therapy.

where in the world?Where in the world is T2K?

We are bringing it back!

Take us on your trip! We know a lot of you are vacationing in some amazing places this summer. Sigh – wish we could come along. Here’s an idea!

Bring this issue with you, or any T2K branded item and take a snap for us of you and your T2000 item on vacation! We will feature you in our next issue. Prizes for the most fun pictures will be rewarded.

patient success story: olivia

14

When I first met Olivia she was four years old, and her family was requesting speech therapy services for Olivia because she had difficulty eating. She had dysphagia (along with a long list of other diagnosis) but more than that she had aversion to food. This was a growing concern to her family as Olivia has a large family and mealtimes are very important to them. Olivia had a G-tube and was only able to eat vanilla yogurt and drink water by

mouth. Those were the two foods that she was not afraid to eat. That was where we started.

Olivia's family was very supportive and worked on all the oral motor exercises, and always included her at mealtimes even though her plate might only have a little bit of yogurt. I was hesitant at first as mom asked me one day, "What is she going to do when she gets older and gets invited out to eat and can only have yogurt?" This was a moment of truth and reality for all of us. Olivia has worked so hard and she has the heart of a champion. Even though she was afraid at times, she trusted her family and me to help her overcome her fear and she started eating. Using many of the techniques taught by Marsha Dunn-Kline in her "Permission to Feed Approach" she left her aversion to food behind her. First she ate soft cream cheese, then mushy cereal, then mashed potatoes. As the months moved to years and the holidays came she discovered the joys of stuffing and ham. Fast forwarding to the present, Olivia eats everything by mouth and only relies on her G-tube for weight maintenance, sometimes getting a tube feeding at night to help her stabilize weight. Olivia's GI doctor and nutritionist are evaluating the necessity of the G-tube at this time. The other day I asked her what her three favorite foods were and she quickly replied, "ham, cheese and hot dogs". We have come full circle from vanilla yogurt and water.

In the beginning of the story, I stated that Olivia had a long list of diagnoses in addition to her dysphagia and aversion

to food, she was born with Pierre Robin syndrome, had a cleft palate, and needed glasses and hearing aids for a bilateral hearing loss. In addition to feeding, we had many other things to conquer. Olivia, the champion that she is, worked hard on improving her speech clarity and learned many new words and started communicating better with her family. She wore her hearing aids some of the time but she complained that they hurt her ears and her family did not push her to wear them all the time.

Another opportunity for training came up through T2K and I attended our 2nd Friday seminar called, "Power Up: Intervention Strategies and Techniques to Improve Outcomes for Children with Hearing Loss", presented by Theresa Caraway. I came back to therapy armed with knowledge for Olivia and her family. We made an appointment for Lucy Liu to come out and mentor me on Olivia's hearing needs. The family understood immediately that Olivia needed to wear her hearing aids 24/7. It has made all the difference in the world. Once Lucy explained the process and suggested that we talk to the audiologist about having an FM system for home use, we wrote the grant to Chari-T2000 and it was approved. Olivia is provided an FM system at school and she reports that she can hear really well at school. Olivia will be having surgery in the months to come and then with her parents, ENT, audiologist, and our team, we will determine if she will still need the FM system.

Olivia is currently home schooled for half of the day and attends school the other half. Her parents take her to a reading tutor every week, and she has started seeing a math tutor as well in her home school program. Olivia and I have been very lucky to have the support of T2K as the training and mentoring program have made a marked difference in the quality of her treatment. The 2nd Friday seminar that I attended addressed a need in a very specialized area for this patient.

Olivia still needs to grow in different ways, but she has taught me that obstacles are only hurdles that have yet to be crossed. Olivia is blessed with a wonderful family and I have been blessed to be walking with them on their journey.

— Ana Rothschild, SLPWest Division

Olivia in her Christmas Dress

The following portion of the story was contributed by Olivia's mother. She wanted to share her perspective on Olivia's experience:

For many years of battling with the dysphagia and severe oral aversion, I truly felt that we would never fi nd someone that could treat that aspect of Olivia’s diagnosis. She had been making decent progress in the area of speech, but she was a fi ve-year-old girl who could barely tolerate three bites of yogurt or baby food. I had started to lose hope that she would ever be able to eat normally or enjoy food. Ana was sent to us on a temporary basis, but her knowledge and past treatment of dysphagia quickly made her the perfect match for Olivia. She soon became our regular speech therapist. Not only did Ana have experience, but she sought out the newest and current treatments and education to better help my daughter. It was an answer to our prayer. Even though her progress was slow, she has come from eating three bites in 2008 to now eating full meals and often asking for seconds! Just last week, Olivia ate her fi rst bowl of ice cream. This is a major step because she has always kept her aversion to very cold items. Now she can take more of a part in our many birthday celebrations! Olivia and our family have truly benefi ted from the services that THERAPY 2000 has provided to us, including: the continual education of staff, offering consults with therapists such as Lucy Liu, and even the possibility of Chari-T2000 providing an FM system. The services they have provided are making a difference for Olivia now, but more importantly, will make a difference in her future. Olivia has made great gains in many areas, and when I think of her future, I can truly see the payoff of many hours of therapy and services. I owe many thanks to Ana, and the staff of THERAPY 2000.

Happy Annivevev rsaryryr

ANNIVERSARIES

Olivia in her Christmas Dress

12 Years

Jerre van den Bent .....................7/1/2000

10 Years

Nancy Estes .................................7/8/2002

Danielle Collins ....................... 8/14/2002

Maryam Berenberg ................. 8/23/2002

Justin Rodriguez ....................... 9/18/2002

9 Years

Eileen Wade .............................. 7/14/2003

Kimberly Spirrison .................. 9/17/2003

8 Years

Yeisha Culp ............................... 8/16/2004

Tran Tran ................................... 8/26/2004

Marc Fagnan.............................. 8/27/2004

Teresa Hutchings ........................9/7/2004

7 Years

Lynn Watters ...............................7/5/2005

Kristin Giggleman .................... 8/16/2005

6 Years

Dava Reynolds ............................7/5/2006

Priscilla Keating ...........................8/1/2006

Dalton Smith ............................ 8/30/2006

Rebecca Andrews .......................9/6/2006

Milford Roque .......................... 9/18/2006

5 years

Ashley Stewart ............................7/9/2007

Jennifer Ramsey ....................... 8/20/2007

Leslie Trillo ................................ 9/17/2007

4 Years

Chessa Jones ...............................7/7/2008

Amanda Treber ........................ 7/21/2008

Heather Pitner ......................... 7/28/2008

Keli Day ........................................8/4/2008

Joseph Valdez ...............................8/4/2008

Jennifer Wells-Rogers ............. 8/11/2008

Jennifer Lawson...........................9/2/2008

Elisabeth Houghton ................ 9/10/2008

Elizabeth Bryant ....................... 9/15/2008

Bernardine Harshman ............ 9/17/2008

Kathy Gamble .......................... 9/23/2008

3 Years

Melody Benson ...........................7/1/2009

Jeffrey Grace ............................. 7/13/2009

Chris Moody-Musick .............. 7/20/2009

Luis Bizama ..................................8/3/2009

Danielle Harston ..................... 8/31/2009

Adriana Muzquiz .........................9/2/2009

Carmen Ojeda-Reyes ................9/8/2009

Pedro Sambolin ........................ 9/14/2009

Shona Marscola ........................ 9/16/2009

Maura Maloney ........................ 9/21/2009

2 Years

Melody Millsap ............................7/1/2010

Alex Paris .....................................7/1/2010

Amelia Rankin .............................7/6/2010

Isaac Lasky ...................................7/8/2010

Amanda Foresman .................. 7/12/2010

Lindsey Stone ........................... 7/12/2010

Brianne Villarreal ...................... 7/12/2010

Tracey Raith .............................. 7/19/2010

Julie Schmidt ............................. 7/28/2010

Toni Barron ..................................8/2/2010

Wendy Cykana ............................8/2/2010

Kristi Hickman ............................8/2/2010

Amber Krumholtz ......................8/2/2010

Lisa Reopelle ...............................8/2/2010

Nicole Giglio ...............................8/9/2010

Michelle Parish ......................... 8/16/2010

Chaim Schnitzler ..................... 8/24/2010

Christopher Rodenberg ...........9/7/2010

Michelle Jenkins ..........................9/9/2010

Edith McCollom....................... 9/20/2010

Kerrie Owens .......................... 9/20/2010

Crystal Brown .......................... 9/24/2010

Brandi Mounce......................... 9/27/2010

1 Year

Lauren Davis ............................. 7/11/2011

Stacy Fitts .................................. 7/11/2011

Karen Biggerstaff ..................... 7/18/2011

Geraldine Cardona ................. 7/18/2011

Mary Jane Weiss....................... 7/18/2011

Emily Schmidt ........................... 7/26/2011

Nichole Lehnerz ...................... 7/29/2011

Jennifer Rosene ...........................8/1/2011

Becky Bloomfi eld .......................8/4/2011

Lisa Chance .................................8/4/2011

Anna Sharp ..................................8/8/2011

Aden Abrego ............................ 9/16/2011

Mary Katherine Arellano ....... 9/19/2011

Melinda Kennedy ..................... 9/26/2011

Adrianna Lacarra ..................... 9/26/2011

Meredith Seibert ..................... 9/26/2011

My journey to t2k kIMMy gIBSon, rn, CaSE ManagEr

For those of you who have not heard my story, I wanted to tell you a bit about myself and how I came to be an RN Case Manager at THERAPY 2000.

At the age of 19, I found myself single, pregnant and without money. At a midwifery center, I delivered a 9 lb. 3 oz. baby boy who promptly decided not to breathe. On the 2nd day of his life, he began having seizures. Jeremiah (Jay) spent ten days in the NICU. During discharge, the medical staff

told me that he would most likely have brain damage and would be mentally handicapped.

Always the optimist, I moved to Dallas with Jay, where I planned to attend school. It was obvious to me that Jay was not mentally handicapped. He followed everything with his eyes and when he laughed, his eyes would twinkle. During my semester in Dallas, I got engaged to the man I had previously dated. When I went home for the wedding my mom pointed out that Jay seemed delayed. To appease her, I agreed to have an evaluation done. The week after my honeymoon we took Jay to Easter Seals. The doctor told my new husband and I that Jay had cerebral palsy. I had no idea what cerebral palsy was, so I told everyone that he would just “walk later” than most kids.

We had two more kids, Stacia and Regan. Regan was born via emergency c-section due to meconium aspiration. For the first four weeks of his life, Regan vomited every time I fed him. At six weeks, they admitted him to CMC for failure to thrive and sent him home with an NG tube. Each day I would get Jay bathed, dressed and fed, make sure Stacia got herself ready and then I would give Regan bolus NG feeds. When he continued vomiting, the GI doctor added night drip feeds to his regimen. Regan often pulled his tube out at night and his feeds would drip all night into the bed. Even with the drip feeds, Regan continued to vomit more often than not. It took him four months before he regained his birth weight.

Since we were already going to Easter Seals three times per week the staff suggested that Regan start therapy. Regan didn’t want to be held or hugged and he wouldn’t interact with anything except the swinging toys on his baby carrier. When I picked him up, he stiffened up and would cry until I put him back.

After months of therapy, the therapists called me in for a conference and told me that they thought Regan was

depressed and that I wasn’t meeting his emotional needs. I was devastated that they thought I was a bad mother. I was under a lot of stress, but I knew that there was some other reason that Regan didn’t want to be held. They never suggested that Regan could be autistic. Instead, they blamed me for his failure to thrive and inability to meet basic milestones.

As Jay got older, it became more apparent that he wasn’t going to walk or talk or hold a feeding utensil. With the assistance of a speech therapist, Jay was taught to look up for yes and shake his head for no. Augmentative communication

devices were fairly new, but I knew that I had to find a way to get one for Jay. We raised money through our church and bake sales and Jay started kindergarten using his own Prentke Romich Light Talker. His first teacher had a breakdown when Jay came to his first day of class and threatened to quit if Jay stayed in her classroom. By the end of the week, Jay had a full time attendant

going to class with him and he never looked back.

While Jay was thriving, Regan was just the opposite. His attention span was less than thirty seconds and he didn’t play with toys. He would walk in circles, shrieking and clapping. The doctors tried different drugs to control his behaviors but nothing worked. Around age six, something changed. Regan would sit for hours doing repetitive tasks and rewinding a video, over and over. The light had gone out of his eyes. The medical community and school didn’t want to diagnose him with autism, because it would force them to provide extra services, so they labeled him MR, with Tourette’s syndrome and severe OCD. Regan was still not eating and was very emaciated. His behaviors were disruptive and I was completely worn down.

When Jay turned sixteen he had surgery to put in a baclofen pump. Jay had never had surgery and despite aspirating on all liquids and foods, he had always been healthy. Because he was so spastic, I would feed him sitting on my lap so that I could control his tongue thrust and his spasticity. After the pump was implanted, the doctor ordered PT for Jay. The therapist just happened to be our very own, Jerre van den Bent. Jay and Jerre hit it off great. Both were big

Kimmy Gibson, RN, Case Manager

Left to Right: Regan, Stacia, and Jay.

teasers and Jerre became close to our family. Jay was not responding to therapy, so Jerre discharged him due to no progress on goals. During the time that Jerre worked with Jay, he told me of his plans to start his own therapy company. Jerre was successful in getting his business up and running and he asked me if I would be on the

Professional Advisory Committee to give feedback from a parent’s perspective. I was more than happy to fi ll this role for THERAPY 2000.

Jay graduated from High School in 2000 and despite being told by everyone (except me!) that he would never be able to move away to college, he did JUST THAT! For the fi rst time in nineteen years, I was no longer his constant caretaker. Someone else would be responsible to feed, bathe and meet Jay’s physical needs. Jay was literally trapped in a body that did not work, with a brain that was completely normal. The only thing he could do successfully was write and communicate and he did this very, very slowly, scanning the alphabet for every word and letter and then making a selection with a switch placed near his head. In college, he often spent up to eighteen hours a day, in his wheelchair, typing out his assignments.

Having newfound freedom for the fi rst time in my adult life, I realized that I needed to start taking care of myself. I joined a gym, lost 80 pounds, got divorced and went to nursing school – all in one year! I had no formal education past high school, but I had lived a very unique life and found nursing to be the perfect fi t for my knowledge base. Despite the excitement of this new path, my body was falling apart from not lifting Jay correctly and not having the tools or the knowledge to realize the strain that I had placed on my back, neck and internal organs.

I still remember the moment when I KNEW that my life was going to be forever changed. I was sitting on a patio with several girls from nursing school. We were enjoying happy hour and I kept looking at my watch, thinking that I needed to hurry home in case Jay needed to go to the bathroom. And then it occurred to me. I didn’t have to be there every two hours just in case Jay needed a drink, or needed to go to the bathroom, or had accidentally wet his clothes. I had given myself 100% to my son for nineteen years, and it was time for me to be OK with putting him in the hands of others. I knew that nobody would ever be able to read his mind or anticipate his every need, but I had given Jay every opportunity to succeed in life and it was now his responsibility to make the best of it.

Upon graduating from nursing school, I worked on the liver and small bowel transplant unit at Children's Medical Center. After four years at the hospital, I received a call from Jerre, asking if I would come and apply to be a case manager for THERAPY 2000. I had always known that this position would be a great match for me. I understood so much about home health, Medicaid waiver programs, feeding and behavioral problems, but most importantly, I understood what the families were going through.

Jay’s spasticity has gotten much worse and he now has a feeding tube. Regan also got a G Tube when he was fourteen. Jay has had eight more baclofen pump surgeries, a pleural effusion, collapsed lung and chest tube, baclofen withdrawal syndrome that brought him close to death, MRSA pneumonia, MRSA in his pump and he had to be revived with CPR after choking on a hot dog in the campus cafeteria. Despite all that, Jay graduated from UNT in 2005 with a degree in Journalism. Jay experienced true college life, which included piercings, a very cool, able bodied girlfriend, going on road trips with his friends, outliving one of his care attendants and living in the community in his own house.

Today, Regan has grown into a mature young man and lives with a full time care attendant. Regan has continued to mature and he no longer has a feeding tube. The fi rst time he said, I love you, was a really big deal. He has learned to have some empathy, and now he says I love you to lots of people. He understands sarcasm, even when it is about him, and it makes him laugh out loud. Regan is perfectly happy in any situation, as long as he has “his things,” which bring him comfort.

I’ve been with T2K over four years and I still have a passion for THERAPY 2000 to be the best that we can be for our patients and their families. I bring my life experiences to work with me, because these experiences form the basis for everything that I do as an RN Case Manager. Therapists that have worked with me know that my door is always open so that we can conference about their patients and attempt to meet the needs of both their patients and their families. Sometimes, my story helps them frame their situation, so that we come up with the best solution for the patient, the therapist and our families.

Jay in college

Regan

18

suMMer survivalSummer can be a challenging time for our therapists out in the fi eld due to weather, changes in patients’ schedules and summer vacations. What are some of your tips and summer survival techniques you use to make your summer successful for you and your patients?

I make my schedule for the entire month during the last week of the month before. This allows me to review with patients more effectively and later if I have a cancelation I know what times I have available immediately to reschedule. I also always try to reschedule the same week of the cancelation if possible so that the rest of the month doesn't have to be more stressful then it already is.Tiffanie Klement, ST

I keep the same schedule I had in the school year. My families are used to the days and times and are more likely to be home for visits. Nancy Estes, ST

Carry water in your car, use window shade, dress cool, don't leave therapy supplies in a locked car – especially a VitalStim unit! Front load appointments.Karen Gillum, ST

A visit calendar for the patient's refrigerator and my cell number listed on it.Elizabeth Darby, ST

Try to get a schedule agreed upon before summer starts.Lizze Norlander, ST

Always carry cooler in car with water and fruit. Encourage families to work on self-care ADLs during summer because of less hectic morning schedule for most families.Lynn Watters, OT

Go over the visits for the following month in an attempt to schedule around vacations ahead of time.Nicole Giglio, PT

Do therapy in swimming pools. Keep water bottles in a cooler in my car. If I have a kiddo who needs work at the playground I meet them at 8:30am or at an indoor mall playground. Elizabeth Bryant, PT

Plan for make ups and take advantage of extra minutes to document. Johnnie Aven, OT

Wear shorts & keep line of communication open. I try to just go with the fl ow, after practicing my deep breathing exercises. Theresa Mai, PT

Bring frozen water bottles in a cooler in the car they melt throughout the day! A small hand held battery operated fan for those houses with no A/C, THERAPY 2000 visor shade, and 1/2 price happy hour drinks at Sonic and Steak 'N' Shake. Maryam Berenberg, SLP

Front loading visits; stressing the importance or doctor's ordered attendance, planning unique summer inspired sessions to look forward to! Leigh Ann Cook, ST

Increased front-loading appointments. (moving the last W/TH to Fridays at beginning of month;) keeping pts. indoors on hot days; schedule pts. in the morning to work on outdoor skills (stairs, trikes & bikes;) aqua therapy for pts. who have pools; chill my water bottles! Kathy Gamble, PTA

I make a schedule with my patients as summer begins. I print out a calendar for the summer months and talk with each family about upcoming vacations (theirs and mine!) and give the family a copy of their schedule with my phone number on it. It has worked well during the summer months!Darla Camacho, ST

For feeding patients, I have started leaving a container or ziploc bag of food for patients labeled speech to avoid it melting or being crushed in my car. Also, I have a mini ice chest that I keep cold water in my car to stay cool during the summer.Patricia Gurinsky, ST

Work with families and other therapists in the home to develop a schedule that minimizes how many days a week therapies are in the home. Attempting a more compact summer schedule with patients with multiple therapies frees up the families to spend more time enjoying their summer and less time stuck at home. Stacey Willmon, OT

Communicate often with the families. Check the weather daily.Lorraine Carey, ST

Water! Flexibility and trying not to sweat cancellations.Chessa Jones , ST

19

I schedule all my after schoolers during the day this way I'm done and out of the heat earlier.Kamie Lancaster, OT

I pack water and fruit and make stops for iced tea frequently to stay hydrated. I encourage my families to give their kids water throughout the day. Meri Linscomb, ST

Carry a small umbrella in your "essentials" pack. I had need of an umbrella on my second day of work...and didn't have one!Irma T Riojas, OTR

Dive in head fi rst at the beginning of the month and be fl exible enough to realize that you will end up with an extra heavy schedule at the end of the month due to unforeseen circumstances. Hey wait...that's every month! ;)Stacy Fitts, ST

I actually encourage my families to keep the same schedule as during the school year because summer goes by fast and that way we avoid scrambling around to fi t in afterschoolers. I try to pad my schedule since some families go on vacations. I fi nd trees with shade and visit Starbucks during long breaks!Vangie Moncayo, OT/SLP

Do you have any favorite products you use with patients that work well this time of year?

Balance board to work inside.Joni Taylor, PT

I do activities related to summer themes like ice cream games or outside games to celebrate summer for articulation, language, gross motor imitation, and use of AAC devices. Patricia Gurinsky, ST

Hands on science experiments, discussion about weather, different clothing and equipment for different kinds of weather, if family is going on a vacation to say Sea World have activities about what they will see on their trip and types of sea creatures at Sea World. Shannon Bowling, ST

Bubbles and pin wheels are always fun. If it’s not too hot then going out and showing the kids how the wind blows the pin wheel then we act like the wind. It's a great oral motor exercise. Tiffanie Klement, SLP

I have made lemonade with some kids (sequencing, following directions). Nancy Estes, ST

I incorporate summer fruits like watermelon into feeding therapy. Bubbles and water toys are fun when we have an

area that we can use that can get wet. I pack a shower curtain liner to put down on the fl oor.Meri Linscomb, ST

A small spray water bottle. Kids generally love to squirt the water out (fi ne motor/hand strengthening/tactile) and it makes for a refreshing summer activity out on the patio, balcony, in the bathroom or kitchen sink.Irma T Riojas, OTR

Swim noodles are great to use for positioning or to hold artic/lang cards. (Cut into approximately 4 pieces. Cut in half lengthwise to sit on fl at surface. Make a slit on top rounded part to make a cardholder to place target cards. )Stacy Fitts, ST

Bubble play outside; thick milkshakes for oral motor work, concentration/memory games to include siblings. Vangie Moncayo, OT/SLP

Bubbles with a fan! All ages like these and the fan helps keep everyone cool. It is amazing the amount of language you get while doing this activity! Tanya Benson, ST

Bubbles, side walk chalk, and more bubbles. ;) Christie Boertlein, PT

Any recommendations for other therapist out there?

Get an iPad. There are some AWESOME apps out there to use with ST patients.Stacy Fitts, ST

Have fun! Make your summer activities have a theme about summer to build on vocabulary that relates to summer activities. Kids love summer and bringing that excitement into the homes with summer activities and summer games and materials is fun for everyone. Keane Byrom, Division Director

Pulling even one new object out of your bag of tricks every once in a while can totally change your session for the best! Stacey Willmon, OT

Don't be afraid to walk through sprinklers you see during the day!Elizabeth Bryant, PT

Keep I'm touch weekly with other disciplines in the home. If you or they have an activity the child really enjoys it could be benefi cial to use the same activity adapted to fi t your goals!Tiffanie Klement, ST

chari-t2000 UpdaTE

Do you have a family that needs transportation for a mobility-impaired child? Chari-T2000 has started a vehicle modification program.

Requirements to get on the Vehicle Modification

List for donation consideration:

• Vehicle must not be greater than 10 years old or must

have fewer than 100,000 miles.

• For vehicles older than five years or having greater

than 60,000 miles, the family must provide an ASE

mechanic’s certification that the vehicle is free of

major mechanical defects. Contact your division

social worker for assistance in locating a mechanic

that can provide this service.

• Family must agree to have a vehicle modification

assessment prior to being listed for consideration.

Chari-T2000 has a vendor agreement that provides

free, comprehensive assessments of the client’s

mobility needs. Contact your division social worker

to set up the mobility assessment.

• The family must agree to pay Chari-T2000 10% of the

final award. Maximum payment would be $1000.

• Funds awarded can be used in conjunction with HCS,

CLASS or MDCP funds when HCS, CLASS or MDCP

funds do not cover the entire cost of the vehicle or

modification. Other funds must be applied first, with

Chari-T2000 contributing the remaining cost up to a

maximum of $10,000, not to exceed the total of all

modification costs.

• If Chari-T2000 funds are not available at the time of

the request, the family would proceed with a vehicle

modification assessment and then would be placed on

a first come, first serve waiting list.

For Final approval of a Chari-T2000 award:

The family will have to submit $1000 (or 10% if a lesser

amount is approved) to Chari-T2000, Inc. Upon receipt,

the award will be granted and the recipient can begin the

process of modification or vehicle purchase.

Formodificationsunder$4000:

The Charity will consider waiving the age/mile requirement.

The family would need to have a vehicle assessment and

provide an ASE Mechanic’s certification to get approval on

a vehicle that does not meet age/mileage requirements.

Contact your division social worker for details.

AwardsareuptoaMaximumof$10,000lifetime

per recipient or family.

We would like to express our gratitude to Jeff Grace andKristin Mycke for the their past service to Chari-T2000.

Visit www.chari-t2000.org

THERAPY 2000 SUMMER NECESSITIES

20

21

Here’s a summertime image for you – ocean waves are crashing against the beach. But you can’t see them because your eyes are closed. The sun is warming your skin. Kids are laughing. You can’t remember where you put your cell phone, and you could care less.

You’re thinking about that massage you got at the hotel spa this

morning. You might doze off any moment. Isn’t summer vaca-tion the best? You get to pamper yourself. You get to send the kids (and your spouse?) off to adventures of their own making. You read a good book. You eat good food. And according to research studies, you’ll see up to an 82% increase in job perfor-mance when you return to work. Additionally, you’ll return to work with fewer aches and pains which mean a healthier and safer workplace. All signs point to the fact that leaving work behind on an extended vacation makes you a better and more satisfi ed employee when you return.

Yet, nearly one out of three Americans will take less than half of their vacation time this year. In fact, only 50% of Americans will maximize their thirteen days of average vacation this year. By comparison, 89% of French workers will take all of their es-timated thirty-seven days of vacation. That’s right, thirty-seven days of vacation for the French on average. Also, Americans are taking their vacation in shorter and shorter increments which don’t have the same benefi ts for the body, stress levels, and work

performance. Twenty-fi ve years ago the average pleasure trip was over a week. In 2012, it’s down to four days.Work and fi nancial pressures might mean that you can’t jaunt off to Hawaii for a full week, but you can still realize the benefi ts of an extended stay-cation. Maybe a couple of days away from home and the remainder of the week around DFW is the an-swer to your sluggish work performance, increased stress, and aching back. Regardless, the quality of most vacations comes down to your ability to disconnect from your responsibilities

and relax your body. Trythesetipsforanimprovedvacationexperienceandreturntowork:

• Planyourdeparture – make a list of your responsibilities and/or projects thirty days before your time-off and start addressing them now. Don’t spend your vacation worrying about what fell through the cracks.

• Delegate – equip your peers and/or direct reports to get things done while you’re gone.

• Set office hours, if youmust – if you need to check email during your break then only do it during certain times of the day. If you can’t manage that, then only carry your phone during certain times of day.

• Sleep – most of us don’t get enough sleep. Vacation is an opportunity to temporarily rectify that problem.

• Planyourreturn - rather than jumping right back into your regular duties, set aside a few hours to reorganize your schedule/tasks, touch base with your peers/boss, and say “thank you” to everyone that helped while you were gone.

vacation or Bust? By Ira kIrklEy, phr, dIrECTor of hUMan rESoUrCES

Live Oak (quercus virginiana)The live oak is also known as the southern live oak. It’s a normally evergreen oak tree native to Texas. If you fi nd a nice, beautiful, shady one we suggest you promply park underneath it.

Sit or Squat appWhen you’re out in the fi eld and hot, you need to fi nd nice, clean bathrooms to use and splash some fresh water on your face. Introducing “Sit or Squat” the app that helps you fi nd your bathroom oasis. It has details of the restroom, star rating, link to reviews, features, and most importantly, whether to “sit or squat”.

The Contigo Stainless Steel Water Bottle The Contigo stainless steel water bottles are WONDERFUL! They remain cold or hot for 8 hours without the traditional breakable lining. They are durable and spill-proof and a nice “green” alternative to a plastic water bottle. Perfect for therapists on the go! Costco: 2/$20

THERAPY 2000 ScrubsThey’re light-weight, great for summer and come in a huge array of colors.

THERAPY 2000 SUMMER NECESSITIES

that helps you fi nd your bathroom oasis. It has details of the restroom, star rating, link to use and splash some fresh water on your face. Introducing “Sit or Squat” the app When you’re out in the fi eld and hot, you need to fi nd nice, clean bathrooms to use and splash some fresh water on your face. Introducing “Sit or Squat” the app that helps you fi nd your bathroom oasis. It has details of the restroom, star rating, link to reviews, features, and most importantly, whether to “sit or squat”.

a nice “green” alternative to a plastic water bottle. Perfect for therapists on the go! Costco: 2/$20

THERAPY 2000 ScrubsThey’re light-weight, great for summer and come in a huge array of colors.

22

Celiac disease is an auto immune disease that is caused by a reaction to a protein in wheat, barley, rye and oats called gluten. It is a genetic disorder that affects at least 1 in 133 Americans. The classic symptoms are, but are not limited to, weight loss, diarrhea and malnutrition. However, some people with celiac disease suffer with no gastrointestinal symptoms at all for years; the disease is still damaging the villi in their intestines.

The only treatment for celiac disease is a strict, 100% gluten free diet for life. That means avoiding all products that contain wheat, rye, barley and oats or their derivatives. It can be a diffi cult task as many of these ingredients can be hidden in lots of processed foods. The key to the success is a complete dedication to going gluten free. That does not mean cutting back on how many doughnuts and Twinkies you eat, it's a full commitment. All or nothing.

Various studies are currently being done to see if a gluten-free diet may help children and adults who suffer from a variety of ailments including; autism, diabetes, heart disease and rheumatoid arthritis.

Hope is not lost for those with celiac disease. There are lots of gluten free options out there that taste great and many restaurants are jumping on the “g-free” bandwagon:

• Maggiano’s• Olive Garden• Sprinkle’s Cupcakes• Boston’s Pizza• Fireside Pies• Company Café• TuLu’s Bakery• Go Picnic- Ready to Eat Meals

One thing that is important to remember is that gluten free is not a diet, it’s a lifestyle.I like to look at it this way: something is poisoning your body and preventing you from functioning properly; causing you pain, weight gain, and many other problems. Why wouldn’t you want to give it up? So going gluten free might seem like a bummer when there are cakes and cookies around, but the positives can far outweigh the negatives where health is concerned!

Here is a simple , fun gluten-free recipe for an easy summer snack.

free to Be gluten- free adrIanna laCarra

One thing that is important to remember is that gluten free is not a diet, it’s a lifestyle.I like to look at it this way: something is poisoning your body and preventing you from functioning properly; causing you

G Free Snickerdoodle Chex Mix!� 1/4 c. sugar or sugar substitute� 1 tsp. ground cinnamon� 2 c. Cinnamon Chex cereal� 2 c. Chocolate Chex cereal� 4 c. popped popcorn

� 1/4 c. butter or margarine 1. In small bowl, mix sugar and cinnamon & set aside. In large bowl, mix cereals & popcorn.2. In 2c. microwavable cup, microwave butter uncovered on Hi for about 40 seconds or

until melted. Pour over cereal mixture, stirring until evenly coated. 3. Microwave uncovered on Hi for 2 minutes, stirring after 1 min. Sprinkle 1/2 of mixture

evenly over cereal mixture, stir. Sprinkle with remaining sugar mixture, stir. Microwave

1 min. longer. Spread on paper towels; cool about 15 min. Store in air tight container. Per Serving (1/2 cup): 100 Calories Total at 3.5 g (Saturated) Sodium 80 mg. Total Carbs 15g (Dietary Fiber 0g) Protein 1 g

23

Division Dirt"She flieS with her own wingS" (oregon state motto)

Meet and eat!

welcoMe the new weSt eMployee

West Division

The West Team had a "Meet and Greet" your DFW Case Managers Potluck Luncheon on Friday, June 15, 2012! Thank you DFW Case Managers for all of your hard work and we are excited to meet and be working with all of you.

Let’s welcome Ren Singh, an SLP intern, to the West Division! Ren is a clinical fellow and will be in the Burleson/Crowley/Joshua area. Her CF supervisor is Liz Capron.

Ren shares a little bit about herself:

• I just graduated from UNT with my MS in SLP• I grew up in Annapolis, MD• I became a SLP because I love children and wanted a career where I could help better their

lives and it is always something different every day• I love to bake things from scratch and am always trying new recipes• I just moved to West Fort Worth with my dog Trixie and am excited to get to know the area

Welcome, Ren! We’re excited to have you on our team!

Updates on the Super Six

Rachel Smith, OT, won the referral trip at the T2K Holiday Party this past December. She and her boyfriend decided to visit Portland, OR. They ran to the west coast for some cooler temperatures before trying to endure the Texas summer!

East Divisionthe north-eaSt diViSion worKS hard & playS hard!

Meet the new north-eaSt eMployeeS

24

In April, the North-East Division had a great time having dinner together and playing Whirly ball! There was some tough competition on the court between the three teams (Offi ce staff, ST, OT/PTs). It’s still in debate which team was the victor.

Shannel Pickens, MS, CF-SLPWe are happy to have Shannel join the North-East Division! She graduated with her master’s degree in December 2011 from West Texas A&M. When Shannel is not working she

enjoys spending time with her extended family. She’s the proud mom of an adorable 6-month-old daughter named Addison. We appreciate Edith McCollom being her clinical supervisor during her clinical fellowship year.

Sara Wilkerson, MS, CF-SLPSara graduated with her master’s degree from the University of Texas of Dallas. She married her husband, Marshall, on May 27, 2012. We heard the wedding was lots of fun. This newlywed enjoys playing video games and reading when she’s not working. Sara’s clinical supervisor is Areti Hadjigeorgiou. We know they will be a dynamic duo!

Central Divisionnew arriVal

Landon James Dorman was born April 1st! He was born at 9:06 pm, weighing 9lbs, 4oz and measuring 20.5 inches long! Congratulations to Rachel Dorman, OT!

25

welcoMe central'S new eMployeeSWelcome Liz IngaPlease join us in welcoming Liz Inga, OTR, to the Central Division. Liz will be working part-time, seeing patients in the Central Dallas/Love Field area. She worked in ECI as an OT for 19 years, which means she has extensive experience with the birth – 3 population. Liz has a 13-year-old son, and enjoys traveling overseas. She loves sports, and her favorite teams are the Dallas Cowboys, and Manchester City (English soccer team). We are thrilled to have her here in Central!

Welcome Diana LundSeen another new face around the offi ce lately? Please join us in welcoming Diana Lund, COTA, to the Central Division. Diana will be working part-time, seeing patients south of I-20, off of 67. She is bilingual, and has been a COTA for 15 years. Vanessa Flores will her supervising OTR. Diana has four grown children, and three grandchildren. She enjoys spending her free time with her family, and going to see the Texas Rangers play. Diana, we’re so glad you’re here with us!

Welcome back Rhonda Gayle, OT!!! We have missed you!

HoustonDivisionMeet the new diViSion director, Kelli appelBaUM

Hi, my name is Kelli Appelbaum and I am the “new kid on the block” in Houston. I am an SLP with 16 years of experience in a variety of settings such as LTACs, private practice, public schools, and university clinics with both adults and pediatrics. I grew up in Houston and returned to Houston after graduate school (University of North Texas 1995). My husband and I live in Sugar Land with our 3 boys (2 dogs and a bird). Some of my hobbies include:

running, fi shing, golf, reading and let’s not forget eating. I try not to take life to seriously and I’m always up for a good laugh. I am excited to be the Houston Division Director and the opportunities that lie ahead for the Houston division.

26

EastTexasDivisionJanie Brown, Part-time, OTR, graduated from TWU with a BS in Occupational Therapy. She has 12+ years of experience including outpatient, home health and school-based pediatrics. Janie will see patients in the Longview, Marshall and Kilgore areas of East Texas. She enjoys spending time with her husband, Troy and her two daughters, Harper (2) and Emma (7), in the limited free time that she has. She also likes to garden and be outdoors in the fall and spring.

Jose Herrera, Full-Time,PTA, graduated from Kilgore College in 2011. He has worked at a local pediatric outpatient facility since graduation. Jose will be seeing kids in the Longview, Marshall, and Kilgore areas. Jose has been married for 3 years and

he enjoys spending time with his wife and 8-month-old son. He loves playing basketball and watching the San Antonio Spurs play. He also likes to ride his motorcycle and listen to positive music. He states that he “loves conversations and can’t help but try and make any occasion an enjoyable time.”

Mellissa Jones, PRN, PTA, graduated from Kilgore College. She has 12 years of experience in the acute care, long term care, geriatric home health and pediatric outpatient and home health settings. She will cover therapy in the Tyler, Overton, Kilgore and Henderson areas. Mellissa enjoys gardening, outdoor activities and spending time with her husband and children.

Luis Lucena, PRN, PTA,graduated from Kilgore College in 2011. He has been working in a local outpatient pediatric facility since graduation. Luis will be providing PT services in the Tyler and Lindale areas. Luis enjoys spending time with

his wife, friends and family. He also plays soccer and occasionally runs 5 and 10K’s in his free time.

Ashley Sparkman, Part-time, PT, graduated from TWU Dallas with a MS in PT in 2007. She has experience

in acute care and outpatient/home health pediatrics. She will provide PT services in the Longview, Hallsville and New Diana areas. Ashley likes to travel, spend time with friends, be involved in Bible study, sew, embroider, exercise and eat lots of chips and salsa and Bluebell Homemade vanilla ice cream.

Rick Stiefer, PRN, COTA, received his Associates Degree in Occupational Therapy from the Navarro College in 2009. He has provided OT in the nursing home and home health settings. Rick will cover after school therapy in the Lindale area. He

states that he’s, “the only guy in the world that likes to shop” so when given the chance, he and his wife spend time together shopping. They also do a nursing home church service on Sunday mornings in Tyler along with his in-laws and a family friend. They are devoted to house hunting in Lindale on Saturday and Sunday afternoons and they like to take their RV out on an occasional weekend.

Maria Campos is the new physician liason for the East Texas Division. She has experience as a nurse’s aide, restorative aide, and working in a long term care/rehab facility. She states that she loves the medical field. She enjoys spending time with her husband, Carlos and son, Cristian in her free time. They like to be outside with their farm animals (goats, chickens and a horse). She also likes to take her son to his soccer practices/games and enjoy good family fun. She states that her sister considers her to be a very “crafty” person.

Kristal Allen, Part-Time, SLP, graduated from Abilene Christian University with an MS in Communication Sciences and Disorders in 2009. She has provided pediatric speech therapy services in the outpatient and school settings. Kristal will

see patients in the East Texas areas of Athens, Canton, Mabank, Malakoff and Gun Barrel City. She enjoys baking, walking, spending time with family and friends and any kind of outdoor activity.

east texas welcoMes new eMployees

27

SanAntonio/AustinDivisionThings are really changing in San Antonio and it’s ALL good! San Antonio now has a Division Director, Adrienne Gaither (pictured left). Adrienne is an Occupational Therapist with 19 years experience and is SIPT certified. Adrienne previously was

the lead program director for Kinetic Kids, owned her owned her own practice, Functional Solutions Therapy Services and served as a member of the multi-disciplinary team at Autism Community Network. Adrienne brings a lot of wonderful experience and energy to our San Antonio division and we are excited to have her on our team.

ch-ch-ch-ch-changes

Kristy Beckham, Part-Time, SLP, graduated from the University of Central Arkansas with her MS in Speech Language Pathology. She has nine years of experience including pediatric outpatient, home health, school, and ECI settings. She will provide speech therapy in the Kilgore, Henderson and Tyler areas. Kristy likes to spend most of her time outside of work with her husband and kids. She has three children under the age of seven that keep her busy. She also enjoys running in her free time.

Teri Speer, Full-Time,SLP, received her MA in Communication Disorders from Our Lady of the Lake University in San Antonio. Teri comes to T2000 with fifteen

years of experience and a back ground in management and treatment in the pediatric home health and school settings and inpatient adult care. She will provide speech therapy services in the areas of Big Sandy, Winona, Red Spring, Gilmer and Longview areas. Teri has two girls ages thirteen and nine. She spends most of her weekends as a cheer mom or softball mom. She also enjoys reading and papercrafting in her free time.

Misty Hood, PRN, SLP, graduated from TWU in Denton in 2011 with an MS in Speech Language and Pathology. She has been working in the school setting since graduation. She also has nine years of experience as a STA in the school setting. She will be covering the areas of Paris, Sulphur Springs and Bogata. Misty enjoys camping, traveling to Colorado, cross-stitching and reading in her free time.

doing whatever it takes for those we serveRebecca Gay, our business office specialist who does authorizations, recently shared something with me that I feel I should share with you because I know how frustrating it can be to deal with insurance companies - especially private/commercial insurance. One of our commercial insurance companies is always a challenge when trying to get additional visits approved above the plan limit. Rebecca recently had two families that she was working closely with to get more visits approved for their children. These families really stepped up the effort in dealing with the insurance company to make sure their children continue to receive their therapy because they said they LOVE our therapists and they have seen so much progress with their children due to their therapy. Both families took the initiative to call the insurance company numerous times and stayed on the insurance company to make sure there was continuation

of their children’s care. They kept in touch with Rebecca and were continually asking her what they can do to assist in this lengthy process. With continuing efforts one mom assisted in getting her daughter’s visit limit approved for another sixty visits to carry her through the end of the year. It has been so nice to see families being so involved with their child’s care and not letting the insurance company dictate otherwise.

Although this does not happen in every case it is encouraging to get these visits approved for the children who really need therapy. It is even more encouraging and hopeful to see a family not give up and go that extra mile because they can see the difference THERAPY 2000 therapists have made in their child’s life. We DO Improve Lives!

– Priscilla

Another change in SA is our move to the team leader model. Beginning July 9th we will have team leaders for each discipline. Teams will consist of 6 – 10 therapists in each “POD”. These leaders will supervise and lead their team members without coming into the offi ce on a daily basis. They will also have their own caseload of 20 patients visits per week. The new Team Leaders in SA are: Lisa Reopelle – ST Team; Michelle Parish – ST Team; Melissa Smith – OT Team; and Joshua Florence – PT Team. Josh is

new to THERAPY 2000 and comes to us from University Hospital where he worked in the ICU. We are excited to roll out this new model and feel that it will give our therapists more individualized leadership, mentorship and supervision when needed. It will take away many of the clerical duties that DM’s have previously been responsible for and allow them to focus more attention on supervisory and leadership tasks within their teams. It also gives our team leaders more fl exibility in their work schedules.

leaders are not Born, they're Made

what’s hot for summer 2012?• TRADER JOE'S opened in Fort Worth!• Exploringlocalresourcesforupcomingactivitiesthatwillbeofinterestto

yourpatientsandparents:• autismspeaks.org• dsptc.org• disabilityrightstx.org• atcoftexas.org/dallas.html• specialneedskidsdirectory.com• dfwchild.com/Thrive/

• NewbarsinBishopArtsDistrictforhappyhour• Ten Bells Tavern/ 232 W. 7th Street• OakCliff Social Club/billiards and beers/English pub/238WDavis

Street• ChihulyattheArboretum• All shades of gray• Broadspectrumsunscreen• Palmwyseupdate• The new t2000.com• H-town• Saltwater pools• T2K Internships• Pops of neon• 2nd Fridays