(2) Recorrmendations giyen in the preceding section highlight te role of IBHS; however,many of these treatment targets and objectives

are relevant to other

types of intervention and supports. For instance, Kendall may end up receiving treatment from multiple professionals (e.g.,occupational therapist,speech-
language therapist,autism support teacher, Behavior Consultant). It will be important for these professionals to collaborate to ensure consistency of their
interventions and to maximize opportunities for Kendall to be able to effectively use her best skills in a variety of different settings and situations.
(3) In addition to IBHS it is recommended that Kendall be evaluated for early intervention (El)services. Given Kendall's age (3 years, 4 months), her parents
may request a developmental evaluation by contacting the Midwestern Intermediate Unit-IV at 724-458-6700 or at 1-800 -345-0033.Please leave your name,
phone number, and a brief message if you do not reach someone directly at these numbers.When considering treatment goals,objectives,and specialized
instruction for El services, consideration should be given to the following:
Kendall should receive as much speech-language therapy as possible with attention to both expressive and receptive language development as well as
development of nonverbal forms of communication such as eye contact and gesture. Collaboration with IBHS providers is important to ensure consistency of
teaching strategies and generalization of skills.
Increasing Kendall's repertoire of functional play skills is an important objective for El and (IBHS) as play development is critical to both
language/communication and social development.
As part of the El evaluation, Kendall's fine motor and visual motor skills should be evaluated. If she is showing a qualifying delay,treatment should focus on
developing the skills necessary to perform adaptive routines such as self-feeding,toilet training, self-dressing as well as skills necessary for appropriate
manipulation/use of toys.

(4) Kendall's parents should continue to supplement future IU-IV services with private, center based therapies (OT and SLT).Again,colaboration among
providers is important.

(5)Given Kendall's diagnosis of ASD,it is recommended that she have a follow-up appointment with Dr. Chaves-Gnecco in the Child Development Unit (CDU).
This is not an urgent requirement but is a matter of best practice to ensure that her physical health needs in relation to ASD have been assessed and
accounted for. Her parents can request the appointment by calling 724-933-8971.Another option is for the family to continue following with Dr.Scott Faber for
Kendall's medical needs related to ASD.

PART A:INITIAL WRITTEN ORDER FOR IBHS TREATMENT INITIATION

It is medically necessary that Kendall Hager receives a comprehensive face-to-face assessment for IBHS.

Along with this Written Order,I have incluacd clinical documentation to support the medical necessity of the services ordered,including a behavioral health
disorder nosis,and measurable improvements in the identified therapeutic needs that indicate when services may be reduced,changed,
or terminated, as per regulations.

A comprehensive,face-to-face assessment is recommended to be completed by an IBHS clinician to further define

hov the recommendations in this order will be used and to inform and complete an Individualized Treatment
Plan.IBHS Treatment Services may also be delivered during the assessment period for stabilization and treatment
initiation provi a treatment plan has been developed for the provision of these services.
in her preschool program. Kendall does have a history of participating in outpatient therapy. She previously received
outpatient speect lgpy for appreximately 5 months until her therapist left for matemity leave, Kendall's
parents report thiat this therapy was inconsistent and unsuocessfal. Kondall just receally started outpatient
speech-Inaguage therapy at Children's Hospital of Pittsburgh(CHP). She remains on an active wart-fist for eccupational
therapy (OT)at CHP.

Safety
A screening was completed for exposure to potentially traumatic events such as physical,sexual,and emotional maltreatment;experience or witness of domestic
violence; neglect;and othertraumatic events.No concering events were identified.

Kendall engages in self-injury,including head banging,as noted above.There have been absolutely no concems for suicidal or homicidal behavior.

Alcohol,tobacco,& other drug use:None.

BEHAVIORAL OBSERVATIONS & MENTAL STATUS