As a member of the Allen Cognitive Network Board, I had the pleasure of attending a board meeting in Los Angeles in February 2007. During this meeting we discussed several important topics with regard to the evolution of the theory. Two important items were discussed that I would like to share with the members of this community.
Update on the ACLS and LACLS
A committee of Allen Cognitive Network board members has spent many years updating the ACLS and LACLS Manual. A working copy of this new manual entitled Allen Cognitive Level Screen – 5 and Large Allen Cognitive Level Screen – 5 will be posted shortly on the Allen Cognitive Network
Once again, this new manual is projected to be provided as a working copy on the Allen Cognitive Network website in the near future. We owe a big thank you to the authors of this new manual including the following individuals:
- Claudia K. Allen, OTR, MA, FAOTA
- Linda Riska-Williams, MA, OTR/L, Chair
- Sarah Austin, MS, OTR/L
- Sandra K. David, MHE, OTR/L
- Catherine Earhart, BA, OTR/L
- Deane McCraith, MS, OTR/L, LMFT
Use of the Placemat Test
The board believes there is a need for additional research to substantiate the validity of the Allen Cognitive Disabilities Model. With that in mind, it is important that the Allen Battery tools be administered according to the administration instructions in order for research to be valid.
If you have participated in our trainings, you know that we advocate for a practical approach to administering the Placemat Test. This is in actuality modifying the administration method outlined. Our clinical experience indicates that we receive similar results through our modified version of simply placing the Placemat pieces as opposed to also gluing the pieces on the canvas and pulling the fringe. This modified method has a real practical advantage in that you can reuse the Placemat test as well as there is a significant time savings in administration. However, this then becomes a modified Placemat test administration that is not closely following the administration and scoring guidelines. Therefore, the board has two requests:
First, please document that you are administering an adapted or modified Allen Placemat Test. Second, if you desire to participate in research, please administer the Placemat Test according to the actual scoring guidelines.
In addition, there are several ADM projects other than the Placemat test. For optimum results the clinician should familiarize him/herself with these other assessment tools in order to best tap into the “will do” component of identifying best ability to function. A future article will be devoted to this topic of additional ADM projects.
Serving Persons With Chronic Cognitive Impairments
As you know, our team is always advocating for and forging the path for therapy services to be provided for those with Alzheimer’s and related dementias. In our teachings we help clinicians to integrate the Allen and Retrogenesis theories into therapy interventions that meet current reimbursement guidelines.
In September 2001 Medicare provided a Memorandum that stated Alzheimer’s and related dementias could no longer be considered an automatic edit for denial of occupational, physical, and speech therapy. This appeared to open the door for qualified therapists to serve individuals with these chronic conditions.
However, it has come to my attention that certain intermediaries and LCDs have been continuing to discriminate. For example, recently, I received a call from a national therapy provider who is having challenges with Highmark Medical Services. It seems that Highmark continues to enforce some edits for these diagnoses. We must do our part to eliminate this ongoing discrimination by educating these organizations on the benefits of therapy intervention for people with Alzheimer’s and related dementias. We must also clearly link our service benefits to current reimbursement guidelines. A very helpful resource document has been created by the Johns Hopkins Commissions Center. This document is entitled Medicare Coverage of Therapy Services: Are the Interests of Beneficiaries With Chronic Conditions Being Met? You may access this document at the following web address: http://medicareadvocacy.org/News/Archives/chronic_JHPaperOnTherapySvcs.103103.htm.
In closing, a clinician who serves people with cognitive disabilities due to chronic dementias must realize we are not working in a static situation. We are practicing in a very fluid environment in which Medicare Reimbursement Guidelines change and new research updates help to influence and shape our intervention opportunities. Each clinician working in this environment should take responsibility for both "painting the picture" to define the reimbursable benefits and outcomes of our interventions and we must also do our part to support the need for ongoing research. Thank you for being a member of this community and for taking the time to read articles such as this. Every little bit of additional knowledge is valuable and can help us to shape our future.