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For establishing Reflective Network Therapy in a Private or Public School Special Education Class: COSTS AND RELATED INFORMATION The following rates for services provided by The Children’s Psychological Health Center (CPHC) apply to full time or part time classrooms. FIRST YEAR: INITIAL TRAINING, ONGOING TRAINING AND SUPERVISION 1. Cornerstone Special Day Class Start-Up Training by Reflective Network Therapist(s) 10,000 certified and authorized by CPHC. (a) Three Full Days of educational and therapeutic staff training prior to implementation. (b) This training will be provided by a senior Cornerstone Therapist and experienced Teacher. 2. Additional On-Site Training during start-up implementation: 10,000 Nine Half-Days of training by Senior CPHC staff SECOND YEAR: REMOTE SUPERVISION and SUPPORT, VIDEO CONFERENCING / TELEPHONE CONSULTATION – TEN 90-MINUTE SESSIONS Remote Supervision by a Senior Therapist: Ten scheduled sessions of 90 minutes each are strongly recommended during the second year. Without such follow-through for the benefit of the staff and the children, CPHC cannot support expectations for the highest outcomes possible using this method. Support will include but need not be limited to video-conferences and telephone consultations.
Ten 90-minute supervisory support sessions as described above (200 per session) 2,000
TOTAL COST FOR TWO YEARS: TRAINING, SUPERVISION AND ONGOING SUPPORT 22,000
---------------------------------------------------------------------------------------------------------------------------------------- ONGOING SUPPORT BY CPHC CERTIFIED SENIOR STAFF Refresher training and training of additional staff by a senior Cornerstone clinician is provided by arrangement at the rate of $125 per hour plus time and travel costs, if travel is necessary for on-site support, supervision and coaching, or, if a Full-Day Training Workshop is deemed beneficial by your Program Director. Much training of new staff can be done by your own already-trained staff, and through video conferencing. ----------------------------------------------------------------------------------------------------------------------------------------
COST SAVINGS & PLANNING Relative Costs of Special Education Enhancement: CORNERSTONE VS. ABA
Cornerstone treatment is usually conducted successfully without one-on-one behavioral aides in the classroom, even if they have been previously assigned. This factor lowers costs substantially. Refer to Chart (below): "Costs of Special Education Enhancement"
Background
The Cornerstone Method of Reflective Network Therapy has been successfully tested in more highly varied educational and community based group settings than has the ABA (Lovaas) method of using one-on-one behavioral aides: public school special education classrooms, preschools, mental health clinics, private therapeutic preschools, homeless shelters, day care centers, and Head Starts. This method has also proven successful in another culture: Cornerstone Argentina in Buenos Aires. 1. Cornerstone therapy is often clinically as well as educationally successful for children on the mild to moderate and sometimes the severe autism spectrum as well as for children having a range of emotional and developmental disorders, including children with multiple diagnoses. In contrast, Lovaas is primarily viewed as an educational response to ASD. 2. Highly significant Mental Health and IQ gains are regularly produced by the Cornerstone method in one school year – far less than the three to four years being reported in scientific studies of the Lovaas’ method. This relative brevity reduces the treatment timeline and therefore the extension of all costs. Additional Reduction of Expenses Related to Staffing 1. The Cornerstone method eliminates the logistic inefficiency and associated costs of pull-out (private office) therapy. 2. Reflective network therapy achieves results using only 15−20 minutes per classroom day of professional psychoanalytic therapist time with each child. The cost of this individualized in-classroom therapy is included in the calculated costs and savings.
3. The calculation in a chart below -- "Recommended Staff Time and Related Costs, Including Training"-- employs representative salary figures for head teachers and teacher’s aides. Salaries will vary in different communities and often will be lower than the figures used below. The chart includes start up costs for implementation in a public school, including teacher and therapist training. Summary of chart: "Recommended Staff Time and Related Costs, Including Training − A chart showing financial feasibility in a public school in terms of staff time"
The total cost for staffing based on the Cornerstone model is $115,175 per 8 children for Cornerstone services during the initial year at a new site. The investment for ABA services during an initial year, for the same number of children and using the same salary figures would be least $320,000.
PLANNING CONSIDERATIONS: Frequency When planning for a Cornerstone therapeutic preschool, it is important to consider research data showing that results are faster and improvements are greater when classes are held more often. Refer to the Research & Results section of our website to review charted peer-reviewed study results: "IQ Correlates with total number of Reflective Network Therapy (RNT) sessions."
Staffing Requirements
Therapist’s Time: Each class requires a psychodynamically trained child therapist in the classroom for a couple of hours each Cornerstone school day. The child therapist must have enough time to work at least 15 and preferably 20 minutes with each child during each Cornerstone service day–usually three to five times a week. The same therapist should be prepared to meet with each child’s caregiver or parent for 45 minutes once a month. The head teacher must be prepared to work educationally with each group daily at least two hours, and to meet with each child’s caregiver or parent three times a month, for 45 minutes. Based on 18 hours total time investment, a typical breakdown of the therapist’s in-classroom time, for a class meeting 5 days each week would be: Weekly Activity -Therapist Hours In-classroom therapy 12.5 Parent guidance 2.0 Teacher /team conferences 1.5 Documentation 1.0 Miscellaneous contacts 1.0 18 hours
Teachers Each class needs at least two teachers per classroom group (head teacher and assistant teacher) and a third teacher if there are more than three highly disturbed or developmentally extremely primitive children in the group. In our experience 8-12 children may be well served with this level of staffing. Results are faster and improvements greater in proportion to the number of class days your therapeutic preschool operates each week. We have tried other models and find it is possible to have an effective Cornerstone with only three children, one therapist and one teacher. Standards and Structure: Essential Guidelines There is a range between certain ideal and minimum standards for practicing the Cornerstone Method of Reflective Network Therapy. However, the following are essential guidelines:
- There must be at least three and no more than twelve children in a group, Children are between ages two and seven. (We don’t have much experience yet with older children, but are interested to try.)
- One child therapist is assigned to each classroom of up to twelve children.
- Each psychotherapy session occurs only in the classroom.
- If more than three children are present, two preschool educators are needed, to conduct educational activities while one child is treated at a time within the classroom.
- Educational activities can occur daily for full classroom days which occur five days a week. They must occur at least two hours a day, at least two or three days a week, totaling at least six hours a week if there are eight patients.
- In-classroom psychotherapy sessions must occur with each child at least two and preferably five separate days a week.
- Each session should be preceded and followed by a “briefing” or “debriefing”.
- Methodical insistence is required on a child’s individual therapy taking place not only in the classroom but in the presence of other children and teachers rather than being in any way hidden from them. Reflection by others is a key feature which is different from most other therapies.
- Weekly parent sessions must occur with a staff member, sharing what has happened in class and home.
- Weekly staff conferences are necessary for sharing what has been going on with the treatment.
- Parental permission should be secured so videotaping can be regularly used to assist at staff conferences, and for objective follow ups.
Chart 1 of 2 COSTS OF SPECIAL EDUCATION ENHANCEMENT Enhancement for eight (8) difficult to educate children – 2 to 7 years old with serious emotional disturbances, or pervasive developmental disorders including autism and Asperger’s disorder.
Chart 2 of 2 RECOMMENDED STAFF TIME AND RELATED COSTS, INCLUDING TRAINING
−A chart showing Financial Feasibility in a Public School in terms of Staff Time Using Reflective Network Therapy Based on a Class of Eight Children meeting 5 days per week for a 45-Week School Year  TOTAL COSTS PER WEEK: $ 2,115 ALL SALARIES FOR A 45-WEEK PROGRAM (2115 x 45) 95,175 STAFF TRAINING PRIOR TO START-UP (3 full days) 10,000 FIRST YEAR – CONTINUING STAFF TRAINING (9 half days) 10,000
TOTAL FIRST YEAR COSTS FOR A CLASSROOM OF 8 CHILDREN: $115,175
For more information please contact: Gilbert Kliman, MD, Medical Director The Children's Psychological Health Center, Inc. −a nonprofit agency
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