Contents: (click on the links below)

Director's Message  

Staff Use Multiple Approaches to Maximize Student's Development  

HMS Students Aid Research Efforts 

In Memorium 

HMS Receives Merck "Touched By An Angel" Grant 

Staff Profile: Meet Heidi Kecskemethy, RD, CSP, LDN 

Parents' Evening Offers Host of Opportunities 

The Parents Corner 

Golf Tournament Swings Another Success for HMS 

HMS Photo Gallery 

This issue of the newsletter describes an interdisciplinary team approach, based on the work of Dr. Stanley Greenspan, being applied in one HMS classroom. I have long felt an affinity with his ideas. His philosophy fits well within a framework of child development compatible with our approach at HMS. Starting from a solid foundation in the norms of child development, we look for ways to apply our understanding in working with children who have disabilities and developmental delays.

Dr. Greenspan’s focus on social desire as a motivator that drives learning also supports our mission to help students function as fully as possible within their various environments. With or without disabilities, we are all social creatures. For our students, who are dependent on others for care and assistance, their ability to relate to others, to project a positive image and to communicate their desires is critical. Our goal is to help them be active, positive participants.

HMS has developed a formal curriculum, approved by Pennsylvania’s Department of Education, providing us with basic guidelines that we modify, enrich and make meaningful for each student. We encourage and support staff exploration of specialized programs and approaches to maximize our students’ growth. Sometimes we invite staff members to pursue specialized training. Alternatively, someone like Ed Contaldi, with personal interest in a particular approach, may invest time in more in-depth study and propose ways to adapt the practice at HMS.

HMS offers a program of professional development for all staff and financial support for continuing education. We regularly present staff in-service programs, drawing on in-house experts and outside consultants.

We want our students to benefit from the expansion of intervention techniques for children with significant disabilities. HMS’ emphasis on interdisciplinary teamwork allows staff to share their own skills and to learn from others, offering our students a winning combination of team commitment and excellence.

Staff Use Multiple Approaches to Maximize Students’ Development

MEANINGFUL INTERACTION. . . Samantha connects with teacher Ed Contaldi during a "Floortime" play session with blocks. Adapting a one-on-one approach developed by Dr. Stanley Greenspan, Mr. Contaldi has been working with Samantha to increase her ability to relate and communicate.

Classroom teacher Ed Contaldi is sitting at a low child’s table across from Samantha, his student. He puts a box of blocks on the table. Samantha opens the box and takes out a block. Ed takes one out, too. Samantha immediately begins to bang her block against Ed’s. He takes her block; she takes his. For several minutes they play together. Samantha focuses on Ed and they seem to follow each other’s cues.

This scene represents a meaningful, social activity and considerable progress in Samantha’s interaction with Ed. Their relationship has grown through an approach that Mr. Contaldi is studying and adapting successfully with students like Samantha. It draws on the philosophy and research of Dr. Stanley Greenspan, a pediatric psychiatrist who has worked extensively with autistic children and their problems relating and communicating. His theories are applicable to other children with special needs.

Dr. Greenspan’s construct of children’s developmental stages provides a framework for assessing the ability to communicate and relate in children with developmental delays. He contends that affect and desire for relationships--initially with their primary caregiver and gradually expanding to include others--drive children’s development, and he has created an interdisciplinary, relationship-based approach to helping children achieve their maximum potential.

Once a professional assesses the child’s emotional, cognitive and motor development, "Floortime" is key to Dr. Greenspan’s recommended intervention. Floortime—intense, one-to-one interaction--calls for operating on the child’s level and using her preferred play activities as a means to build interaction. "I need to put energy into what Samantha wants and her preferred toys, not what I want," Mr. Contaldi says. "Her investment in our interaction and relationship will in turn fuel her learning."

Dr. Greenspan’s approach has spawned an organization--Interdisciplinary Council on Developmental and Learning Disorders (ICDL) — that meets and produces writings centered on his theories and practice; a trademark intervention — DIR^®/Floortime (Developmental Individual Difference Relationship-based Approach); and a certification process for practitioners. Mr Contaldi, who has read widely in the Greenspan literature, attends local ICDL meetings.

Dr. Greenspan stresses the need to identify each child’s unique make-up and challenges, including ability to integrate sensory stimulation. Most of Mr. Contaldi’s students have sensory needs affecting their ability to relate, and he works closely with occupational therapists who have completed training in sensory integration (SI) theory.

Lisa Drechsel, Samantha’s OT, notes that aspects of SI theory lend themselves to Greenspan’s developmental stages. If we look at neurological thresholds, "Some children need a lot of stimulation and sensory information before their neurons ‘start to fire’ and allow them to respond to what their teacher is presenting. Others need less stimulation for arousal and more easily go on overload," she says.

Samantha needs a lot of stimulation to be aroused and alert. "Each child has a ‘sensory diet,’" Ms. Drechsel says, "and for Samantha, movement is a big part of her diet." Ms. Drechsel has developed, with Mr. Contaldi, a program of daily activities such as swinging in suspension equipment, power mobility and rides in a bolster chair, that help Samantha to develop better body/spatial awareness. Ms. Drechsel and other team members, including speech and recreation therapists, also incorporate Mr. Contaldi’s curricular themes and materials in Samantha’s therapy sessions, to reinforce developmental skills he is promoting.

Her physical therapist, Debbie Zlotnick, works on posture, strengthening Samantha’s trunk muscles to hold herself upright, making her more alert and ready for interaction. Just before Samantha’s play session, Ms. Zlotnick exercised her on a large ball. Samantha’s bouncing movements strengthen her abdominal muscles and arouse her, enabling her to bring more attention to the blocks activity.

Mr. Contaldi’s goal is to help Samantha become more flexible and complex in her interactions and to express more joy. In their twice-a-week floortime sessions, "I’ll begin to change the parameters of our play, presenting her with different activities and stimuli," he says. He also works on cognition skills such as ability to imitate, retrieve hidden objects, improve visual and motor control and sustain longer periods of interest.

Supported by HMS, Mr. Contaldi and other team members are patient with small steps and gains. Samantha has come a long way and their team collaboration will support her continued growth.

HMS Students Aid Research Efforts

MEASURING GROWTH PARAMETERS. . . Heidi Kecskemethy (top left), researcher at duPont Hospital for Children and HMS nutrition consultant, measures Ryan’s shinbone. The physical data is part of a study to gather information about the growth and development of children with cerebral palsy who live away from home. The study also gathers data about participants’ bone density. 
Ethan (top right) relaxes, with help from HMS recreation therapist and nurse Rich Magnuson, as he prepares for a DXA bone density scan at duPont Hospital.

Some HMS resident students are participating in a research study to gather information about the growth and development of children with moderate to severe cerebral palsy. Funded by the Nemours Foundation in collaboration with the Alfred I. duPont Hospital for Children, the study’s co-principal investigators are HMS medical director Dr. Steven Bachrach of duPont’s Department of Pediatrics and Dr. H. Theodore Harcke, Department of Radiology. HMS nutritionist Heidi Kecskemethy, duPont senior research assistant, serves as study coordinator. Several HMS staff received training through duPont to assist with the study.

The one-time observational study collects data for each child, including a questionnaire for parents about their child’s health and medical history, a physical assessment and a three-day nutritional-intake record. Ms. Kecskemethy has also measured several physical-growth parameters--height and weight, skin fold thicknesses and length of the upper arm and shinbone. Finally, students have traveled to duPont Hospital for a low-radiation bone density test (DXA) that Ms. Kecskemethy will analyze along with their nutritional data.

An ongoing national study—the North American Growth in Cerebral Palsy Project—has been gathering the same information about children with cerebral palsy who live at home. Now, the HMS data, pooled with data for children living at two residential institutions in Ohio and South Dakota, will provide comparable baselines for children with cerebral palsy living away from home.

The study enables researchers to look at the interrelationships between medical issues, nutrition and other health measures and how they impact the child’s growth and to compare data about facility-based youngsters with identical data about children living at home.

Ms. Kecskemethy points out, "We’re particularly interested in this information because of the children’s many medical issues. This study will continue to increase our understanding of cerebral palsy. It could affect and improve the quality of care for future children."

HMS Receives Merck "Touched By An Agency" Grant

HMS has received a $1,000 grant from Merck, thanks to the efforts of senior investigator David Wise, father of Melea, who nominated HMS as one of 11 agencies selected this year to receive grants in honor of the employees who benefited from their services. Mr. Wise’s nomination stressed HMS’ impact on Melea’s development, including her ability to communicate and drive a power wheelchair. "The staff of HMS School is an amazingly caring, creative, energetic and special group of people…A special gift they gave to me was the first time my daughter touched some buttons on her talker and she said, ‘I love you Dad.’"

HMS is grateful to Mr. Wise for his generous support and nomination and to Merck for their gift.

 Click here to view Mr. Wise's nomination essay. 

In Memorium

HMS students and staff note with deep sadness the passing of their friend, Eric, who died August 12, 2004 at age 16. Eric, a student at HMS for 10 years, was the son of Laurie and Art Axberg and loving brother of Steven and Logan.

A memorial service in Eric’s honor, held at HMS on September 22, included a eulogy written by Eric’s Aunt Gwen. Despite profound sadness, she writes, "Every time I think of Eric, I am filled with such joy. Can you hear his rollicking laugh in your mind now and not smile?…Eric taught us that no matter what your challenges in life may be, joy is found in the smallest things."

Staff Profile: Meet Heidi Kecskemethy, RD, CSP, LDN

Nutritionist Heidi Kecskemethy has flourished during a 15-year career encompassing clinical, public health and research roles in maternal and child health. She has served as patient services manager in hospital settings and as chief clinical dietitian for three hospitals, most recently the Alfred I. duPont Hospital for Children, where she has worked for nine years. Six years ago, switching her focus to research in pediatric bone density, she helped to develop a technique for measuring bone density in children with disabilities that she has taught to hospitals nationwide. She is an expert in analysis and interpretation of pediatric bone studies.

Ms. Kecskemethy has also had a private practice in pediatric nutrition and for the past seven years, has served as nutrition consultant for HMS School.

Earning a BS in Nutrition from Penn State, she completed a dietetic internship at the Medical College of Virginia. A Registered Dietitian (RD) by the American Dietetic Association, a board-certified Specialist in Pediatric Nutrition (CSP) and a Licensed Dietitian Nutritionist (LDN), she is also licensed in Delaware as a medical radiographer for bone densitometry.

At HMS Ms. Kecskemethy’s role continues to evolve. Responsible for menu planning with the food services department, she trains dietary staff and consults on issues such as food allergies. She conducts student nutrition assessments and provides nutrition education and counseling for students. As a resource to staff, she leads in-service programs, collaborates in multidisciplinary efforts with nursing, speech and LSA’s and promotes staff wellness with programs like "Walk Across America."

Despite her professional commitments, Ms. Kecskemethy--who for seven years moved around the East as a Navy wife--is devoted to her daughters, ages 11 and 13 and to the family’s dog and hamsters. She coaches middle school field hockey and enjoys music, reading, gardening, exercise and home improvements.

Parents' Evening Offers Host of Opportunities

Twenty families attended an activities-packed Parents’ Evening in October to network, meet with staff and hear a presentation by Joseph Scullin, Director of the Community Social Services Department for United Cerebral Palsy in Philadelphia.

Mr. Scullin focused on transition planning, urging parents to put their child’s name on a waiver list now. Key to most services at age 21, the waiver can also provide helpful services for younger students.

Parents talked with their child’s teacher and speech, occupational and physical therapists as well as with nursing, the nutritionist, physician and social worker. Nutritionist Heidi Kecskemethy spoke with families of resident students participating in a duPont research study. A Met Life representative was also available to discuss long-term financial planning for children with special needs.

HMS facilitated attendance with childcare, dinner and programs for students and their siblings, while parents enjoyed dinner in the assembly room during the presentation and shared experiences with other families.

The Parents Corner: by Ilene Brent

Parents’ Evening this year was very informative. Joe Scullin from UCP in Philadelphia is a great resource about services for the disabled. It was so kind of him to visit with us.

I was surprised that few parents have taken advantage of waiver services through the Mental Health/Mental Retardation office. Several years ago I met with my caseworker to ask for help. Melea was growing, gaining weight and becoming harder for me to lift. Luckily, my wonderful caseworker developed a waiver budget for Melea, including money for a Handi-Move Lift System for my home, a new wheelchair lift for the van, an aide for Melea and respite care.

In the beginning finding an aide was difficult and frustrating. Some came for a few weeks, then quit. Others stayed for only a few months or did not work out. Finally we have a wonderful woman, Debbie, who comes in the evening to help care for Melea’s personal needs. I realize Debbie may not be with me forever and that I may need to go through the same process to find a replacement.

Another advantage of using waiver services is that Melea is now in the system and her transition into another facility after graduation may be smoother. Over the years, I’ve had many caseworkers. I’ve learned how important it is to keep in touch. Make sure the caseworker knows you, your child and your needs.

If you are not taking advantage of waiver, call your caseworker for an appointment. It could be one of the best things you do for your child.

Golf Tournament Swings Another Success for HMS

Dance movement therapy at HMS received a big boost from the proceeds of the 14th Annual Fall Golf Classic held in October at Twining Valley Golf Club in Dresher. Netting $12,000, the tournament provided participants a great day of sport, comraderie, fun and prizes.

For the fifth year, the tournament’s founders and organizers, Vince Mazzei, Mike McDermott, Todd Strauss and Chris Welde made HMS the beneficiary of their community service. HMS thanks this generous foursome for their efforts and commitment to the school’s program and offers appreciation to the many sponsors and donors who supported the tournament’s success.

HMS Photo Gallery

LOVING PET THERAPY WORKS. . . Krysti (center) reaches out to touch Chance, a pet rabbit that resides in HMS’ courtyard, while recreation therapist Karen Scheer and student Kristin look on. The girls participate in a pet/horticulture group who care for Chance, feed the school’s fish and clean their tank and also do some gardening. Students love to pet and brush Chance—he’s a real motivator.

MAKEUP ANTICS. . . John smiles approval of his face makeup during the school’s annual Halloween celebration.

TWO TO TANGO. . . Two dancers from the acclaimed Broadway production, "Forever Tango," visited HMS during the show’s Philadelphia run in November. In addition to their dramatic performance, the visitors chatted and danced with students and taught basic steps to interested staff. Here LSA Kevin Lowery (left) and Music therapist Brad Biedermann try to follow the male dancer’s lead.