Simplifying the Science: Addressing Vocal Stereotypy or “Scripting”

Many parents and teachers struggle with addressing vocal stereotypy or “scripting” in children with autism. Since stereotypy is frequently automatically reinforcing, (meaning that the behavior is maintained by the sensation produced by the behavior) it is especially difficult to address. While this type of behavior does occur in typically developing children (think of a young child singing the same song repeatedly for several weeks or a toddler repeating a newly learned sound) there is concern that this behavior persists in children with autism and other developmental disabilities in such a manner that it interferes with learning.

In 2007, William H. Ahearn, Kathy M. Clark, Rebecca P.F. McDonald and Bo In Chung published a study in the Journal of Applied Behavior Analysis entitled Assessing and Treating Vocal Stereotypy in Children with Autism.” The study defined vocal stereotypy as “any instance of noncontextual or nonfunctional speech and included singing, babbling, repetitive grunts, squeals, and phrases unrelated to the present situation.” It focused on four learners (two boys and two girls) who had autism and were referred for the study because their vocal stereotypy interfered with their ability to learn. The children ranged in age from 3-11. Three of them used speech to communicate while one used PECS.

The study describes potential interventions from previous research before introducing its goal of interrupting the vocal response then redirecting. This is called RIRD – Response Interruption/Redirection. In RIRD, when the child made an inappropriate vocalization, the teacher blocked them by interrupting immediately, then redirecting them to another behavior. The redirection involved prompts for vocal behavior such as saying “Where do you live?” or “Say ‘red.’” When a child made an appropriate vocalization, it was always followed by a teacher comment.

RIRD produced substantially lower rates of stereotypy for all four of the children and an increase in appropriate vocalizations for three of the children. One thing that is striking about these results is that “sessions were 5 min in duration, and two to three sessions were conducted 3 days per week.” This is a degree of time commitment that is replicable in the home or school environments.

If your child or student is presenting with stereotypy that interferes with learning, it is valuable to look at this study, as well as similar studies by Cassella, Sidener, Sidener, & Progar (2011) and Athens, Vollmer, Sloman, & Pipkin (2008). Consult with a BCBA or ABA provider for assistance in implementing the intervention.

Pick of the Week: Speaker’s Box – Expand expressive vocabulary & language

Ideal for auditory and visual learners, Speaker’s Box helps strengthen oral language skills in whole-class or small-group settings, as well as in one-on-one instruction. This week only, take 15% off* your order of Speaker’s Box by using promo code SPEAKER at checkout.

With Speaker’s Box, students reach into the box, choose a color-coded prompt card, and then start chatting. There are four color-coded categories included:

  • What’s Happening Here?/What Comes Next? has the students talk about what is going on in the picture or what might happen next.
  • Step by Step has students look at the picture and correlating question on the back to give detailed directions on how to do something.
  • Would You Rather? presents questions that students answer with a personal statement based on the first thing that comes to mind.
  • Things You Like Best also asks students questions about their preferences and to explain why.

This is a great teaching tool that fosters receptive and expressive language, peer interaction, perspective-taking, and more. The set includes eighty-six 2.5-inch square write & wipe-cards (14 are blank for customization) in a nifty storage box. This game is recommended for children ages 6 and up.

Don’t forget to use our promo code SPEAKER this week to save 15%* on your set of Speaker’s Box.

*Offer is valid until 11:59pm EST on November 11th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Tip of the Week: Communicating with Paraprofessionals to Support Your Learner

Many students with autism and other developmental disabilities have an IEP that mandates a 1:1 paraprofessional (called an instructional assistant or teaching assistant in some states, but referred to as paraprofessional for the purposes of this article). Recently, I had the opportunity to provide a workshop to a large group of paraprofessionals in New York City. I was surprised to hear how some felt disconnected from the families of their students, especially considering how deep their relationships are with their students.

My conversations during that workshop caused me to reflect upon my own experience as a classroom teacher. Fortunately, I always had wonderful paraprofessionals who were essential to making the classroom run smoothly and helping our students achieve success, but I recognize now that they often were working with less information and less contact with the families than the teachers were. As a parent/guardian, you can help bridge that gap.

  • Communicate directly with the teacher and the paraprofessional. If you have critical information about your child, don’t assume that the teacher will share it with the paraprofessional. This can be important for big issues, such as allergies or new medicines, as well as smaller issues, such as an impending vacation or a sleepless night.
  • Share important goals with the paraprofessional. In many schools, the paraprofessional may never have seen your child’s IEP, though they frequently see your child for more time during each day. The paraprofessional also will usually see your child at times when the teacher will not, such as lunch and/or recess. If there are specific concerns about social skills, the paraprofessional likely has more opportunities for implementing social skills interventions than the teacher.
  • When you go to parent teacher conferences, ask both the teacher and the paraprofessional about your child’s performance in school. Because the paraprofessional sees the student in more environments, they may have more specific observations about transitions, special classes such as gym or art, and social interactions outside of the classroom.
  • Sometimes a student responds better to the paraprofessional than the teacher. If they do, find out why. The paraprofessional may be doing things that you and/or the teacher can replicate to help your child’s learning outcomes.
  • Show your appreciation for the paraprofessional. The job of a paraprofessional is very challenging: no preps, the need to adjust to each teacher’s style throughout the day, and the fact that they often end up managing any behavioral challenges during the day. A note of thanks can go a long way. And if you are the type of parent who gives small gifts or handmade items to teachers, don’t leave the paraprofessional out!

WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Pick of the Week: Social Skills Games to Teach What’s “Just Right”

People communicate using not only words, but also tone of voice and body language. Many children, however, fail to notice these relatively subtle social cues in self-expression and personal space. This week, we’re featuring two of our newest social skills games, Too Much, Too Little, Just Right and Too Close, Too Far, Just Right to help you teach your learners what is “just right” in social situations. Use our promo code JUSTRIGHT to save 15%* on your sets!

Too Much, Too Little, Just Right teaches children to pay attention to tone of voice, observe body language, and note how these cues affect the message. Children assume two roles during game play: Messenger and Listener. They learn by observing others and by getting immediate feedback about their own expressive abilities. They learn to adjust volume, expression, gestures, and other physical cues in order to communicate effectively and achieve greater self-control, thus developing more appropriate and satisfying social relationships.

Ideal for 2 to 8 players, this game can be easily used with larger groups or classrooms as well. Because it focuses on social interaction rather than on a game board, the game can be played virtually anywhere. Clearly focused and easy-to-use, Too Much, Too Little, Just Right is an outstanding tool for those working with children who have autism spectrum disorders. The game includes: 45 Too Much/Too Little/Just Right Cards, 90 Message Cards, 64 Action Cards, 50 Response Cards, 100 Reward Chips, and 1 Feedback Express-O-Meter. Recommended for children ages 5-12 years.

Too Close, Too Far, Just Right teaches what’s “too close,” “too far,” or “just right” in social situations. Children take turns performing social scenarios described on the Role Play Cards, and then the instructor or group of students decides whether their proximity to each other is appropriate for the particular situation. The objective is to understand the concept the personal space. Focused and engaging, this game is a gentle way to help students with autism and ADHD grasp the idea of appropriate proximity and physical boundaries and thereby improve their relationships. The game includes 65 Role Play Cards, 24 color-coded Feedback Cards, 3 “Where do I stand?” Cards, 1 Footprint Mat, and 1 booklet with instructions, game preparations and play, and variations on game play with a large group or class. Recommended for children ages 5 and up.

Don’t forget to save 15%* on your order of Too Much, Too Little, Just Right or Too Close, Too Far, Just Right this week by using promo code JUSTRIGHT when you check out online or over the phone with us!

*Offer is valid until 11:59pm EDT on November 4th, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Registration Open for Bridge Kids of NY’s Specialized Social Groups – Winter Session

If you’re in NYC, you must check out these Specialized Social Groups offered by the wonderful folks at Bridge Kids of NY. With a team of professionals who strive to improve the quality of everyday living for children and families, BKNY presents several fun and interactive social groups to support children in their social, communication, and behavioral growth. Below are two groups in which you can now enroll your child for the upcoming winter session:

Bridge Kids Social Circle
This fun and interactive group meets on Tuesdays or Thursdays, and is a 50-minute social skills group for children ages 2–5 years who experience difficulty in socializing with peers. Through play and group activities a qualified therapeutic team will focus on key social behaviors such as:

  • Eye-Contact
  • Taking Turns/Sharing
  • Understanding Personal Boundaries
  • Utilizing Appropriate Social Language
  • Initiating and Maintaining Social Interactions

Bridge Kids Happy Eaters Group
This group meets on Tuesdays or Thursdays, and is designed for our little ones who are “picky eaters”. If your child often refuses new foods, presents with a limited range of accepted foods, and/or engages in problematic behavior surrounding mealtimes, these skilled therapists can help! This group focuses on:

  • Creating Positive Mealtime
  • Experiences
  • Introducing New and Nutritious Foods
  • Healthy Exploration of Food
  • Simple Food Preparation
  • Supporting a Healthy Mind and Tummy

Register your child now in these specialized social groups for the upcoming winter session. Both groups meet for 10 sessions each at 4:00 PM on Tuesdays or Thursdays.

Guest Article: Tackling Tantrums by Bridge Kids of New York

For parents, it can be difficult and frustrating to help their children through tantrums. We’re pleased to share with you a second guest post by Bridge Kids of New York (BKNY), who shares with us a few (humorous) words of advice on tackling tantrums.

T-A-N-T-R-U-M-S
by Bridge Kids of New York

Young girl indoors cryingHere at BKNY, parents reach out to us for support in a variety of areas. Not surprisingly, one of the most popular reasons we hear from parents is for support in managing tantrums! Why is this not surprising? Well, it’s not surprising because very few of us will make it through life without ever throwing a tantrum! We’ve all been there, right? Whether you were 5 or 35, you’ve most likely engaged in a tantrum. For our little ones, who are still learning about rules, expectations, effective behavior, and self-control, it makes sense that we will periodically see a tantrumit’s often part of the learning process. So, for all of our parents out there who are tackling tantrums, here are a few words of advice for you:

Take a deep breath
Analyze why the tantrum is occurring and Avoid reinforcing it
Neutral tone and affect
Tune out the bystanders
Remember the big picture
Understand that this is a learning moment for your child
Make objective decisions rather than emotional ones
Stop beating yourself up

Take a deep breath.
Tantrums can be stressful for everyone involved! As a parent, it may be emotionally difficult, frustrating, or potentially embarrassing to work through a massive tantrum with your child–these are common emotions! But here’s the thing: when your child is mid-tantrum and about as far away from calm as possible, that’s when it’s the most important for us to be calm. After all, someone has to be! Whatever emotions you feel in these moments are perfectly valid—acknowledge themthen take a deep breath and try to release them. One of the most important things you can do for your child during a tantrum is to remain calm

Analyze why the tantrum is occurring and Avoid reinforcing it.
All behavior occurs for a reason. Whether or not you fully understand your child’s tantrum, rest assured that there is a function behind it. In order to handle it appropriately and use proactive measures in the future, we need to analyze what is going on. We need you to become a tantrum detective! Think about what happened right before your child’s tantrum (i.e. the antecedent). Were you talking on the phone instead of paying attention to her? Did he have to share a favorite toy with another child? Did you ask him to do something challenging? Looking at what happened right before will probably give you some information about why the tantrum is happening. Thinking about (and potentially reconsidering) how you typically respond in these situations may also help. Once you determine why the tantrum is occurring, the next step is to not give into it. So, if your child is tantrumming in the middle of the grocery store because you said “no” to the box of over-processed chocolate cereal, you want to make sure that you do not give in and buy the cereal. If you cave during a tantrum, you will likely reinforce that behavior and see it again in the future. So do your best to stay strong!

Neutral tone and affect.
We’re all human and it’s natural to lose our cool from time to time under stressful circumstances. Tantrums can get the best of you sometimes! In these moments, try to remind yourself to use a neutral tone and affect. Let your face and your voice send the message that you are unphased by the tantrum (even if you don’t totally feel that way on the inside!). Channel your inner actor (we’re in NYC after all!) and put on your game face!


Tune out the bystanders.

Let’s be honest, a tantrum that occurs in your home feels very different than a tantrum that occurs in public. When you are out in the community, there may be additional safety concerns (e.g. running into the street), worries about disturbing others (e.g. crying in a restaurant or movie theater), and, perhaps the most challenging of all, those darn judgmental bystanders! You know the ones we’re talking about. Those people who either can’t relate to what you and your child are going through, or the ones who pretend like they can’t relate because, after all, their children NEVER, EVER, EVER had tantrums (read: sarcasm). Then, there are also the people who get involved, thinking they’re helping you, but are actually making the situation worse. You know these people toothe sweet older lady who tells your child that Mommy will buy him a candy bar if he stops cryingyou’ve met her, right? Unfortunately, you cannot always control what other people will say, do, or think. But, fortunately, you can control what YOU will say, do, and think! In these moments, do your best to turn OFF your listening ears and do what you know is right for your child.

Remember the big picture.
Okay, so here were are in the middle of a huge tantrum. Could you make that tantrum stop in a matter of minutes or even seconds? Yes, in many cases you probably could. All you have to do is give in. If your child is tantrumming because you told her you would not buy that candy bar in the checkout line, you could probably put a quick end to it by just caving and giving her the candy. And that option can be pretty tempting sometimes! This is where we urge you to remember the big picture and think long-term. The goal is not to stop that particular tantrum in that particular momentthe goal is to reduce those tantrums from happening in the long-run. We want to decrease the behavior that interferes with your child’s success and increase the behavior that supports itthat’s not going to happen by giving in. Caving in the middle of a tantrum may stop it in the moment, but ultimately it will teach your child that throwing a tantrum is an effective way to get what he wants. So the next time he wants something, he’s likely to resort to that behavior again. As you can imagine, this may easily turn into a cycle of increasing tantrums. Although it’s easier said than done, try to remember the big pictureyou’ll thank yourself later!

Understand that this is a learning moment for your child.
Every moment of every day is a learning moment. This applies to all of us, by the way, not only our children! Believe it or not, your child is actually learning during those tantrums. He is learning all kinds of things, in fact! Your child is learning whether or not Mommy really means the things she says. She’s learning whether or not you are consistent. He’s learning about rules and limits, or lack thereof. She’s learning what behaviors are going to be effective and what behaviors are not. He’s learning how to respond to undesired situations, like not getting what he wants. The list could go on and on! So remember this when your child is having a tantrum and focus on teaching the things you actually WANT to teach! Furthermore, remember that learning is hard sometimes. It’s okay for your child to struggle a little bit in the learning processyou (and we!) are there to be his teachers.

Make objective decisions rather than emotional ones.
We’ll start this one by acknowledging that it can sometimes feel nearly impossible to be objective during a massive tantrum, especially when in public. To the best of your ability, set your emotions aside and try not to take it personally. Your child’s tantrum is happening for a reason and that reason is most likely not about trying to hurt your feelings. So, take a moment to have a mini out-of-body experience, away from your emotions, and try to look at the situation as an outsider. Remember, you want to analyze what is really happeningunfortunately, those pesky emotions can really cloud your judgment. Try to let your choices and reactions be based on facts rather than on feelings.

Stop beating yourself up!
You are not a bad parent. Your child is not a bad kid. You are not the only parent whose child has tantrums (despite those ridiculous people who make you feel like you are!) In fact, your child’s tantrum may actually be the result of you being a good parent and setting limits. You do not have to be perfect every second of every day. You can make mistakes and so can your child. It’s okay. This is a part of the process. Chin up, thumbs up, you got this!

Note: If your child engages in behavior that is dangerous to himself or others, we suggest that you consult an appropriate medical professional as well a Board Certified Behavior Analyst (BCBA) immediately. Safety should always be the first priority. Feel free to reach out to our behavior team and/or attend one of our Tackling Tantrums workshops for more information on understanding and changing behavior!


WRITTEN BY BRIDGE KIDS OF NEW YORK, LLC

Bridge Kids of New York, LLC is a multidisciplinary team of professionals who strive to improve the quality of everyday living for the children and families they serve, providing each family with progressive services that merge evidence-based practices with play-based and social instruction. To find out more, contact them here or email info@bridgekidsny.com.

Increasing Play with Unit Blocks – Free Download

Blocks PileSymbolic play refers to a child’s ability to use one object or action to represent a different object or action within imaginary play. The symbolic play skill that involves object substitution typically begins to emerge around 18 months. For example, you might observe a child using an empty box for a “hat” or an overturned bucket for a “drum.” Blocks are a mainstay in early childhood classrooms because the benefits are innumerable. Block play can help to facilitate cooperation, visuo-spatial skills, problem solving ability, social skills, and language development, and is a good predictor of future mathematical abilities.

One hallmark of the diagnostic criteria for autism spectrum disorder is a presence of “persistent deficits in social communication and social interaction across multiple contexts, as manifested by difficulties in sharing imaginative play or in making friends.” Additionally, rigid thinking patterns may make symbolic play difficult for children with autism as they might view objects in a limited way that makes it difficult to pretend a block is something other than a block. Blocks on ShelfSince unit blocks are a huge component of early childhood classrooms everywhere one could imagine that exposure to them and some level of proficiency opens up huge social opportunities for learners with autism spectrum disorders with their mainstream peers in the classroom.

Some learners will require scaffolding in order to progress from the use of literal props within pretend play to object substitutions. Research suggests that systematic prompting is a common component of successful interventions used for teaching play.  Depending on the learner, various types of prompts will be used as you systematically move from most intrusive to least intrusive prompt levels. Sometimes, a learner begins to respond to natural cues before you have moved through each prompt level. However, for learners that require support froma visual prompt you can attach drawings of objects onto the blocks and then systematically fade them out. Once the learner begins to consistently use the blocks with the attached images you can use stimulus fading procedure to fade out the visual prompt. This can be done by photocopying the image and systematically changing the lightness until eventually the learner is presented with just the block.

Below you will find downloadable images in the shape of unit blocks to help you facilitate symbolic play with a learner who requires visual prompts. The images are to scale and just the tip of the iceberg when it comes to all of the possibilities. It is important to teach various object substitutions for each block shape so that the skill is generalized. In a classroom where the curriculum is organized thematically, you could attach a few visuals to various blocks each time the theme changes to encourage symbolic play for the whole class.

Click here to download our Free Unit Blocks Template!

References

Cook, D. (1996). Mathematics sense making and role play in the nursery school. Early Childhood Development and Care, 121, 55-65.

Wolfgang, C., Stannard, L. & Jones, I. (2001). Block play performance among preschoolers as a predictor of later school achievement in mathematics. Journal of Research in Childhood Education, 15(20): 173-180.

Smilansky, S., & Shefatya, L. (1990). Facilitating play: A medium for promoting cognitive, socioemotional and academic development in young children. Gaithersburg, MD: Psychosocial & Educational Publications.

Christakis, D.A., Zimmerman F.J., & Garrison M.M. (2007). Effect of block play on language acquisition and attention in toddlers: a pilot randomized controlled trial. Arch Pediatr Adolesc Med. 161(10):967-71.

Pepler, D.J., & Ross, H.S. (1981(. The effects of play on convergent and divergent problem solving. Child Development, 52(4): 1202-1210.

Lang, R., O’Reilly, M., Rispoli, M., Shogren, K., et al. (2009). Review of interventions to increase functional and symbolic play in children with autism. Education and Training in Developmental Disabilities, 44(4), 481– 492.

Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis, 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall.


Written by Stacy Asay, LMSW

Stacy is a licensed social worker, providing home and school based services to children and their families in the New York City area. With nearly 16 years of experience, her work with special needs children integrates a strengths-based, holistic approach to child and family augmented with the tools of Applied Behavior Analysis, a methodology that allows for reliable measurement, objective evaluation of behaviors, and the systematic teaching of language and learning skills.  This results in an individualized curriculum that equips children with the tools they need for learning and living while honoring their unique spirit.

Pick of the Week: Inference Card Decks – Learn to infer meanings through critical thinking and auditory comprehension

Oftentimes, people do not communicate a complete message; they assume their listeners are also interpreting important visual information. Help students learn how to determine the “true” meanings of messages and improve their critical thinking, auditory comprehension, and inferencing skills with our newly added inferencing card decks: Look, Listen & Infer and the Inferencing Big Deck. And this week only, take 15% off* your order of either or both of these inferencing decks, by using promo code INFER14 at check-out!

Look, Listen & Infer is a 56-card illustrated set that will teach students to infer the meaning of a message by both listening to a statement or question, and also looking at the picture for important visual cues. One side of each card shows a colorful illustration of the scene. The other side presents the scene and asks, “What should you do next?” followed by three possible answer choices, one of which is correct.

 

 

 

 

 

 

 

 

The Inferencing Big Deck features 100 large 5″ x 7″ photo cards that contain a short story along with with six follow-up questions to help children improve their ability to correctly inference. The color-coded topic areas include: Associations (These items belong to…); Identify the Setting (Where is this?); Part to Whole (What is it?); Predicting (What happens next?); and What Happened?

Don’t forget – you can save 15%* this week on your order of Look, Listen & Infer and/or the Inferencing Big Deck by using code INFER14 at check-out online or over the phone!

*Offer is valid until 11:59pm EDT on October 21st, 2014. Not compatible with any other offers. Be sure there are no spaces or dashes in your code at check out!

Simplifying the Science: Using a MotivAider to Self-Monitor

Teaching independent on-task behavior can be quite challenging when working with any student, but particularly so with some students with autism. In a study published in 2010, researchers Dina Boccuzzi Legge, Ruth M. DeBar & Sheila R. Alber-Morgan implemented and evaluated one way of teaching student to self-monitor their on-task behavior using a MotivAider. (The MotivAider is a simple electronic device that vibrates at timed intervals to provide an individual with a private prompt to engage in a specific behavior. It can be programmed to vibrate on a fixed or variable schedule at different duration and intensity levels.)

In this study, the researchers worked with a fifth grader with autism, a sixth grader with autism, and a fifth grader with cerebral palsy. They taught the boys to wear the MotivAider (calling it a pager) and note a + or a – to indicate their behavior each time the MotivAider vibrated. The behaviors they monitored were all related to being on-task: “eyes on my work,” “in my seat,” and “doing work.” Once each boy consistently rated his behavior upon feeling the vibration, the researchers implemented the intervention.

The MotivAider’s were initially set to vibrate every two minutes. Each time the MotivAider vibrated, the student would mark a + or a for each of the behaviors on a sheet he had on his desk. Prior to the intervention, the average percentages of time each boy was on-task ranged from 26% to 77%. Upon implementation of the intervention, “all three students showed an immediate and substantial increase of on-task behavior ranging consistently from 80% to 100%.

The researchers also included a plan for fading out the use of the MotivAider‘s, changing from a fixed schedule of every two minutes, to an increasing variable schedule. The fading schedules varied for each student. For example, for one student, the fading schedule started with a variable schedule of a vibration about every four minutes, then moved to about every six minutes, then to about every eight minutes, and then to about every ten minutes. The MotivAider was then removed completely.

After the intervention was complete, researchers collected data once a week for three weeks to see if the intervention was maintained. During all three maintenance probes, “all students continued to demonstrate 80%-100% on-task behavior.”

We’ve talked about how to use MotivAider‘s in the past, but I particularly love this intervention because it is feasible for teachers to implement in the classroom, promotes independence in learners with autism, and allows teachers to focus on other issues. Take a look at the study here to get a fuller description of how to implement such an intervention with your students.

For more information about the MotivAider, click here.


WRITTEN BY SAM BLANCO, MSED, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals. Sam is currently pursuing her PhD in Applied Behavior Analysis at Endicott College.

Best Cities for People with Disabilities

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Overland Park, KS is the number one city for people with disabilities, according to a new ranking from WalletHub. (Overland Park CVB / Disability Scoop)

Here’s an interesting finding. For people with disabilities, what city is “best” to live in? According to consumer finance website WalletHub, it looks like Overland Park in Kansas is the nation’s best city for people with disabilities to call home. Each of the 150 ranked cities was analyzed based on 23 factors, from cost of living to effectiveness of the state Medicaid program.

Where does your city rank?

 

Ranking Names Best Cities For People With Disabilities