The Ontario Autism Program Recommendations

TheOntarioAutismProgramRecommendationsPresentedbytheOntarioAu2smCoali2onDecember7,2016

Copyright2016.OntarioAu2smCoali2on

WhatisASD?•  Neurodevelopmentaldisordercharacterizedbydifficultyinsocialinterac2on,verbalandnon-verbalcommunica2onandpresenceofrepe22vebehaviourand/orrestrictedinterests

•  Lifelongdisability•  Notwoindividualsarethesameandtheimpactonfamiliesanddailyfunc2oningvary

•  Severityofsymptomsvary…thereforenotallindividualswithASDrequirethesameintensityofservicesandthequalita<venatureoftheservicesmayvaryaswell

•  Nocure,howevertherapeu<cinterven<onscandrama<callychangethequalityoflifeforthoselivingwithASD


WhatisABA(AppliedBehaviourAnalysis)•  Themostwelldocumentedandempiricallysupportedtherapeu2cinterven2onforASDisABA

•  Scienceofbehaviourfocusingon“analysis,design,implementa2onandevalua2onofsocialandotherenvironmentalmodifica2onstoproducemeaningfulchangesinhumanbehaviour”(ABAGuidelinesforASD,BACB)

•  SupportedbydecadesofresearchtoimprovesymptomsofASDandhasevolvedoverthedecadestohaveabroaderscopeofprac2ceandprocedures


TheOntarioAutismProgram:Mission•  Toprovideempiricallyvalidatedtherapeu2cservicesandsupportsforchildren,youthandadultswithASDandtheirfamiliesthatarebasedoneachindividual’sandfamily’sneedsandul2matelyhelpimprovethequalityoflifefortheindividualandtheirfamilies

•  ToprovideabroadscopeofABAservicesandsupportstotheparentsofindividualslivingwithASDbasedontheirneedswiththeaimofimprovingtheirabilitytoprovidesupportandfostergreaterindependentlivingforindividualswithASD


Preface•  Promo<onof“evidencebased”interven<ons

•  Implementmosteffec2vemethodsinaccordancewithABAresearchandABAbestprac<ces

•  Elimina<onofthetermsIBIandABA•  IBIisanONTARIOterm•  Wemustmovetoamoreconstruc2veandbroaderscopedterminologyNOW:

•  ComprehensiveABA/IntensiveABA•  30-40hoursperweek

•  ModerateABA•  11-29hoursperweek

•  FocusedABA•  10hoursorlessperweek

•  Otherwisetreatmentdeliveredsub-op2mal

•  Buildonexis<ngsystemsinfrastructurethatalreadyaimstoprovidesupportsbasedonneed,e.g.MCSSDevelopmentalServiceOntario/PassportProgramforindividualsolderthan18years

•  Individualsmustbeabletoaccessthesystemasneededovertheirchildhood,asneedsof

individualchanges,e.g.teenageyears

•  Theschoolsystemisnotequippedtoprovidecomprehensive,moderatedorfocusedABAintheclassroom

•  Recogni2onthatprofessionalcapacityforBCBAwithspecialisminASDisbuilding(pleaserefertotheSEGreport)


FlowofServices1.Referralfor

MinistryFundedABAServicestoMCYSRegionalOffice

2.IntakeandApprovalbyMCYSRegionalOffice

3.Selec2onofProviderand

SubmissionofServicePlan

4.ApprovalofServicePlanbyMCYS

RegionalOffice

5.ABAServiceDelivery

6.Transi2ontoMCSSDevelopmental

ServiceOntario(at18years)

6.Transi2ontoComple2onof

Service








RegionalOffice





Service


Step1.ReferralforABAServicestoMCYSRegionalOfIice•  ParentsubmitsIntakepackagetoMCYSRegionalOffice

•  Intakepackagecomprisedof:1.  Standardintakeform(similartoDevelopmentalServiceOntario)2.  Proofofdiagnosis3.  ReferralforABA.ApprovedReferralSources(similartoCalifornia

BillSB946)•  Medicaldoctor(familyphysician,pediatrician,neurologist,psychiatrist)•  Psychologist•  PsychologicalAssociate

•  Criteria:•  DiagnosisofASD

•  CriteriaNOTbasedonseverityofASD•  CriteriaNOTbasedonageofindividualwithASD•  CriteriaNOTbasedonanyco-morbidcondi<onsofindividualwithASD








RegionalOffice





Service


Step2.IntakeandApprovalbyMCYSRegionalOfIice•  FileassignedtoMCYSStaff“Coordinator”•  Coordinatordetermineseligibilitybasedontransparentadministra2vecriteriaNOTclinicalcriteria(noreassessmentisrequiredandnoexclusioncriteriabeyondanASDdiagnosis)

•  Ifindividualapprovedforservices,MCYSStaffCoordinator:•  Providesinforma2ontofamiliesregarding:

•  OnlineregistryforServiceProviders•  Communityresourcesforfamilies•  Onlinewebinars(e.g.whatisASD,whatisABA)

•  Assignscasemanagertoindividual/family








RegionalOffice





Service


Step3.SelectionofProviderandSubmissionofServicePlan•  ParentsselectMCYSapprovedProvider•  Ac<vi<esofapprovedprovider:

•  Reviewsfile•  Interviewsparents/individual•  Conductscomprehensivebehaviouralassessmentusingcurriculum-

basedassessmentsindividuallyselectedbasedindividual’sneeds(e.g.VB-MAPP,ABLLS-R,EFL,AFLS,PEAK,SocialSkillsChecklist)

•  DevelopsIndividualizedServicePlanandReportincludingrecommenda2onsfortreatmentdosage(focused,moderatedorcomprehensiveABA)basedonindividualizedneedsandevidencefromliterature

•  Reportincludesspecificgoals,informedbyindividualandfamilieswithASD(wherepossible),parents/caregivers,treatmentteamandotherprofessionals(whereappropriate)andhowgoalswillbemonitoredthoughtheuseofdirect,observableandmeasurabledata(seep.24ofBACBhealthcareguidelines)


ClinicalTeam•  Theclinicalteammayberepresentedbythefollowingprofessionals

•  ClinicianinCharge:IdeallyaClinicalPsychologistorotherwiseanRHPwitheduca2onandexperienceinchilddevelopment

•  SeniorTherapist:IdeallyBoardCer2fiedBehaviourAnalyst(BCBA,BCBA-D)•  Amaster’sdegreelevelorhighercer2fiedbehaviorprac2cingwithinthescopeofhisor

hercer2fica2on•  CanconductABAassessment,treatmentplandevelopmentandupdates,anddirectone-

on-oneABAservices•  InstructorTherapist:

•  BoardCer2fiedAssociate/AssistantBehaviourAnalyst(BCaBA)•  Asupervisedbachelor’sdegreelevelbehaviorspecialistwhoprovidesABAservices

underthesupervisionofaBCBA/BCBA-D•  Assistantbehavioranalystscannotprac2ceindependently

•  RegisteredBehaviourTechnician(RBT)•  AsupervisedABAteammemberwhomeetsspecifiedtrainingrequirementsandcan

provideone-on-oneABAservicesunderthesupervisionofanauthorized(BCBA/BCBA-D)

**GivenlimitedcapacityofBCBAsinOntario,thosewithspecifictrainingandexperiencewhoarenotmembersoftheBehaviorAnalystCer2fica2onBoardBACBmaybepartoftheteam(pleaserefertotheSEGreport)UNTILSUFFICIENTCAPACITYINONTARIOBUILDS


ApprovedTeam

BCaBA

BCBAST

IT/RBTIT/RBT

ClinicalPsychologist/PsychologicalAssociate

(RHP)CIC

*RHP=RegulatedHealthProfessional.RHPmayalsobeaBCBA.

Occupa2onalTherapist(RHP)

SpeechLanguagePathologist

(RHP)

PhysicalTherapist(RHP)


Note:SometeamsmaynothaveaBCBASometeamsmaynothaveaBCaBASometeamsmaynothaveaRBTCIC=ClinicianinChargeST=SeniorTherapistIT=InstructorTherapist

SampleProgram•  For40hourperweekof1:1ABAProgram

•  40hoursofIT2me(1:12mewithindividual)•  Minimumof8hoursofsupervisionbySeniorTherapist:supervisionofITs,reportwri2ng,developmentoftreatmentplan

•  NOTE:presentcapacitywouldnotenable8hoursperweekofsupervision.Theremustbeflexibilityandfluidityascapacitybuilds

•  ClinicalPsychologist/PsychologicalAssociatefunc2onsasClinicalSupervisorduetotheirexper2seinthedevelopmentalapproachtoservicedelivery(thisispresentlyaconten<ousargumentbetweenBCBAsandClinicalPsychologists)








RegionalOffice





Service


•  ServicePlanapprovedbasedon:•  Feeguidelines•  Creden2alsofprovider(s)•  Supervisionofprovider(s)(mayrequirevirtualsupervisioninremoteareas)

•  Recommenda2onsforclinicalinterven2oni.e.focused,moderated,comprehensiveABA*

•  Datacollec2onandmonitoring•  Componentofparenttraining•  Inter-professionalcollabora2on(e.g.SLP,OT,SchoolStaff)•  ApprovalbyindividualwithASD/family

•  Ini2alServicePlanauthorizedfor6months*Decisioncanbechallengedbyimpar2alreviewcommikeeifparentdoesnotagreewithMCYS

Step4.ApprovalofServicePlanbyMCYSRegionalOfIice


FeeGuidelines-UseofFeeScheduletoEstablishRates: •  Feeguidelinesperdiscipline:

•  IT•  BCaBA•  BCBA•  ClinicalPsychologist•  PsychologicalAssociate

•  Associa2onofprofessionalswhocanprovidesugges2onsforfeeschedule(similartoFSCO,OntarioPsychologicalAssocia2on,OASIS,OntarioPhysiotherapyAssocia2on)

•  Nofeescheduleatpresentbutcanbedeveloped•  DirectpaymenttoserviceprovidersIDEAL








RegionalOffice





Service


Step5.ABAServiceDelivery•  Implementa2onofServicePlan•  Increasedsupervisionduringfirstfewmonthsofservicedelivery•  Useof<eredservicemodeldeliverysystemandinclusionofRegulatedHealthProfessionalswhoareclinicallyresponsiblefortheindividual’scase

•  Ongoingdatacollec<on•  Modifica<onofServicePlanbasedonresponsetointerven2on•  Comprehensivebehaviouralassessmentconductedevery6months•  Familyengagement•  Inter-professionalcollabora<on(similartoschoolsystem)•  Ongoingrepor<ngtoMCYSRegionalOfficeevery6months(atminimum)includingclinicalrecommenda2onfromClinician-in-Charge.Reportincludescurriculumassessmentdata,masteryofindividualizedtargetsandgoals

•  OngoingapprovalbyMCYSRegionalOfficeCopyright2016.OntarioAu2smCoali2on







RegionalOffice





Service


Step6.Transition•  Transi2onto“Comple2onofService”orTransi2ontoDevelopmentalServiceOntario(atage18years)

•  Decisiontotransi2on/dischargemadebyclinicaljudgment

•  Transi2ontoComple2onofServiceonlyifoneofthefollowingcriterionaremet:•  Evidenceofmasterygoalsoftreatment•  Individualnolongermee2ngdiagnos2ccriteriaforASD•  Frequent/chronicmissedsessions•  Lackofprogressongoalsacrossmul2plereviewperiods•  Familyini2ateddischarge•  Unresolvedconcernsrelatedtotreatmentbetweenfamilyandserviceprovider(BACB,2014;CalABA,2011)








RegionalOffice





Service


Step6.Transition•  Atminimum6monthspriortocomple2onofservice,clinicalteamdevelopswrikenplaninconsulta2onwithparent,communitycaregivers,andothersinvolvedprogramthatincludes:•  Specificdetailsofmonitoringandfollowupforbothindividualandthefamily

•  Descrip2onofrolesandresponsibili2esofallproviders•  Effec2vedatesformasteryofbehaviouraltargets

•  Comple2onofservicemayinvolveafadingoutprocess•  Comple2onofServicefromComprehensiveABAmayinvolvetransi2ontoModeratedABAandthentoFocusedABAprogramasappropriate

•  Transi2onac2vi2esandrecommenda2onsareimplementedbyindividual’sClinicalTeam

•  Collabora2onwithexternalserviceprovidersasappropriateCopyright2016.OntarioAu2smCoali2on

IndependentReviewforAutismServices“BehaviourAnalysisReviewCommittee”(basedonCaliforniaCodeofRegulations)•  Availableasanarm’slengthmechanismtoappealdecisionsbyMCYSCoordinator

•  Responsibleforreviewandconsidera2onforapprovalordenialofbehavioranalysisinterven2onsbyMCYSCoordinator

•  Members:•  3individuals

•  OneRegisteredPsychologistwhoprac2cesBehaviourAnalysis•  Onelicensedphysician•  Oneclientadvocate

•  PhysicianorPsychologistmusthaveatleast:•  3yearsexperienceinbehaviouranalysis


KeyReferences•  Programoutline:

•  TRICAREAu2smCareDemonstra2onwww.tricare.mil/~/media/AB11B82994884EB3A5AC108E18E4EAC0.ashx

•  Regula<ons:•  TheBehaviourAnalysisCer2fica2onBoard(BACB)

•  ProfessionalandEthicalComplianceCodeforBehaviorAnalystswww.bacb.com/wp-content/uploads/2016/03/160321-compliance-code-english.pdf

•  AppliedBehaviourAnalysisTreatmentofAu2smSpectrumDisorder:Prac2ceGuidelinesforHealthcareFundersandManagershkp://bacb.com/asd-prac2ce-document/

•  CanadianCodeofEthicsforPsychologistswww.cpa.ca/aboutcpa/commikees/ethics/codeofethics•  TheCollegeofPsychologistsofOntarioStandardsofProfessionalConductwww.cpo.on.ca/

•  Selec<ngABAProviders•  ConsumerGuidelinesforIden2fying,Selec2ng,andEvalua2ngBehaviorAnalystsforIndividualswith

Au2smSpectrumDisorders.PreparedbytheSpecialInterestGroup(SIG)oftheAssocia2onforBehaviorAnalystshkps://calaba.org/media/content/ABAAu2smSIG-ConsumerGuidelines-Rev2007.pdf

•  AppealMechanisms•  CaliforniaCodeofRegula2ons

hkps://govt.westlaw.com/calregs/Document/I457CB750D60711DE88AEDDE29ED1DC0A?viewType=FullText&origina2onContext=documenkoc&transi2onType=CategoryPageItem&contextData=(sc.Default)


Documents

The Ontario Autism Program Recommendations