Puddingstone Place plants first seed in Middleboro

Feb. 22-- Feb. 22--MIDDLEBORO -- Mattapoisett resident Aimee Perry describes an improving but still-fractured network of therapies and services when looking back on what once constituted the best-available treatment plan for her now 13-year-old daughter Rowan.

Rowan, who is autistic, has required a wide array of services since her diagnosis at 15 months, and mom saw to it she would have access to whatever was needed to develop and improve communication skills, relieve and treat anxiety and sensory difficulties and provide direction in the areas of diet and feeding, education and family life.

It wasn't always easy, with prescribed services rarely offered near home -- or outside of Boston -- and never under any one roof. And her experience is not unique, she says.

"Parents travel so far... nothing's down here, truthfully," Perry said, referring to her own South Coast neighborhood in particular. "We always have to go up to Boston. When we go to get evaluations, they're like 'why are you up here?' Because there's nothing down here.

"It is starting to matriculate, there are satellites; it is getting better, I'm not gonna say it's not. But for the most part, nobody's giving you a map and saying this is the route you should go."

In the past year, though, things are coming together. She's driving less and most of the services Rowan relies on are provided just a short ride away in the nearby town of Middleboro.

Puddingstone Place opened doors in Middleboro last year on April 2 -- Autism Awareness Day -- offering a unique approach to treating autism spectrum disorder and a range of other development disabilities. The center in Middleboro is the first of what is envisioned as a nationwide network of treatment centers working to replace systemic disorganization and far-and-wide adventures with a unifying, collaborative thread. Two more treatment centers have since opened in Wellesley and Danvers.

Puddingstone Place has an exclusive license with Boston Children's Hospital and follows the "visual-based curriculum" developed by Dr. Howard Shane, Director of the Center for Communication Disorders and the Autism Language Program at Children's Hospital Boston.

The center is on the forefront in the use of Shane's Visual Immersion System. VIS for short, the program aims to engage and improve communication and language skills through the use of various Augmentative and Alternative Communication (AAC) systems -- a combination of methodology and technology which makes language and communication accessible to a wide array of patients.

At Puddingstone Place, therapists customize a program for each individual, starting with an assessment of what works best -- some patients work at improving spoken language, while non-verbal patients can work with sign language or digitally-displayed symbols and/or real world representations and photographs, depending on what works. Once that basis for language and exchange is established, therapists can program the device of choice -- think iPad or tablet -- and implement and continue to develop a highly-individualized plan.

The overriding goal is to integrate the plan into daily routines, with well-defined parameters and preferences in language and communication as the common thread connecting treatment, educational/vocational pursuits and family life. To help support and simplify the process and care, Puddingstone Place offers many different services at each location, with a focus on Speech Therapy, Applied Behavioral Analysis and Occupational Therapy.

"We take that combined approach and we use it to customize specific programs for every single one of our patients," said Elaine Crosby, Puddingstone Place founder and CEO. "And not just patients with autism, not just children... we work with all ages, with various developmental disabilities."

It's all about getting, being and staying "on the same page," says Colleen MacWilliam, Puddingstone Place Regional Director and Speech Therapist.

"If a family comes in and they have very specific goals that they want to work on for their child, we can create a curriculum for that and then help that family carry that over at home and at school," said MacWilliam, a Lakeville resident who studied under Dr. Shane at MGH Institute of Health Professions. "At school, they might be specific academic goals, and we can also work on family specific goals... on top of all of the language goals, occupation goals and behavioral goals."

MacWilliam says Puddingstone Place therapists are available to meet with teachers and school staff to share strategies and carry over work that is done at the center to student life, and in some cases, they're already collaborating with local schools to better serve their patients.

Perry has since signed on as President of the Parent Advocacy Group at Puddingstone Place in an effort to get the word out about the center to area families who've had similarly disjointed experiences accessing services for a special needs child. And she's hopeful Rowan's current trajectory continues right on track and provides a sustained model for the future.

"It's still evolving and it's still new, and that's the thing that I like about it," Perry said. "If you bring something up and say, 'hey, this is probably something that would be good to integrate,' they're so open to it. If they see the wisdom in it... it's like, 'yes, let's have that be part of it.' Like, they do food therapy here, which is huge. A lot of times you're traveling huge distances to do that. And they work with the parents, to help us continue the work at home.

"It's just a level of collaboration, support and crossover that I've not really ever experienced before."

Dr. Shane said the model can translate and take root in the public school setting, and the program is making inroads in that direction. But he says currently schools are not equipped with the precise technology and cannot accommodate the highly-personalized diagnosis services that are central to the Puddingstone Place model.

Widespread implementation of the programming is a long-term goal, but for now, the plan is to do the hard work at the centers and grow from there.

"I think that schools and educators are certainly well meaning and they understand their role and responsibility to provide education, and in the case of children with different disabilities, to provide services to accelerate their learning and to improve their communication and social skills," Dr. Shane said. "The problem is that they don't have enough therapists. Even when they have qualified therapists, the case load might be 50 or 60 children.

"Really -- it's my clinical impression from doing this work for many years -- in order to be successful you need to approach the individual on the autism spectrum, and those with other developmental disabilities, intensely, and that means immersing them into an environment where it's not just that they go off to speech therapy two or three times a week for half an hour... they need to be in an environment where the visual supports and the technology are used for every lesson."

With diagnosis rates of autism spectrum disorder increasing yearly, Crosby hopes Puddingstone Place will be a leader in the push to provide more cohesive and collaborative treatments and services for autism and developmental disabilities.

"There's got to be an ongoing solution," she said. "There are a lot of centers out there, and a lot of activities and therapies out there, but to have a concrete solution where you're able to take a certain method or approach that is effective and evidenced based and be able to train parents, use it in the schools and use it in the centers... that will be the fastest and most effective treatment. And that's what we're hopeful about."

For more on Puddingstone Place, visit puddingstoneplace.com or call 800-804-5041. Puddingstone Place Middleboro is located at 47 East Grove St.

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