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©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario CANS Conference 2011 Baltimore, MD Autism Spectrum Program – Eastern Ontario Application.

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Presentation on theme: "©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario CANS Conference 2011 Baltimore, MD Autism Spectrum Program – Eastern Ontario Application."— Presentation transcript:

1 ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario CANS Conference 2011 Baltimore, MD Autism Spectrum Program – Eastern Ontario Application of a TCOM Implementation Lise Bisnaire, Ph.D. Heather Woltman

2 Abstract Delivering personalized transition services to children on the Autism spectrum: Evaluating the impact of structured assessments on program performance and team processes. Personalized service models, individualized child- and family-centered approaches to delivering services in accordance with the Total Clinical Outcomes Management framework, are increasingly prevalent within the child serving system and therefore warrant evaluation (Lyons, 2004; MCYS, 2008). A formative evaluation of an Autism intervention program facilitating student-specific school-based transitions in Eastern Ontario, Canada examined the programs capacity to personalize its services to meet clients unique needs, strengths, and preferences. The program provides coordinated and seamless transitions for children with Autism Spectrum Disorder who are transitioning from Intensive Behavioral Intervention (IBI) (an intensive form of ABA services) to Applied Behavioral Analysis (ABA) instructional settings in schools (Ontario, MCYS/MEDU, 2010). Specifically, the evaluation assessed the programs use of a communimetric tool (Child and Adolescent Needs and Strengths-Autism Spectrum Profile; CANS-ASP) to assist teams in planning and carrying out personalized transitions. By assessing the process by which the student-specific school-based transition program uses the CANS- ASP to deliver personalized services, factors supporting or impeding this aim are identified and recommendations for enhancing service delivery are made.

3 Learning Objectives 1. Assess the capacity of the program to tailor its services to clients unique needs and strengths using TCOM* 2. Examine the value of using the CANS © to assist program aims. 3. Identify factors that support or impede the ability of student-specific transition teams to deliver personalized services to children and their families.

4 Statistics Tell Us… Recent studies show the prevalence of ASD is approximately 1 child in 91 (Published online October 5, 2009 - http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1522v1)http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1522v1 Autism is diagnosed 4 times more often in boys than in girls (Fombonne et al., 2006) Asperger is diagnosed 10 times more often in boys than in girls (Fombonne et al., 2006) In Ontario, there are an estimated 80 000 individuals with autism, 20 000 under the age 20 Retrieved April 2009 from http://www.autismontario.com/Client/ASO/AO.nsf/object/WAAD+Media+09/$file/WAAD+Media+09.pdf ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

5 Autism Spectrum Program Autism Intervention Program- Eastern Ontario (AIP-EO) School Support Program (SSP-ASD) ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

6 Autism Spectrum Program Autism Intervention Program (AIP-EO) Objectives: 1. To provide IBI to children at the severe end of the autism continuum 2. To provide associated services (Child/Family supports; Transition Support Services) in collaboration with other services 3) To develop capacity in family members to provide appropriate behavioural interventions that support services received in the AIP School Support Program (SSP) ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

7 AIP-EO What we do: Program eligibility, on-going review and discharge assessments Intensive Behavioural Intervention (IBI) therapy to children (centre and home based) Funding for private IBI services (DFO) Preschool/school transition supports Parent Education Research ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

8 Autism Spectrum Program Autism Intervention Program (AIP-EO) School Support Program (SSP) Objectives: 1) To enhance the knowledge of school board staff with respect to the characteristics of students with Autism Spectrum Disorders & principles of Applied Behaviour Analysis, effective behavioural teaching strategies and other evidence-based strategies as appropriate 3) To enhance linkages between schools, school boards and lead agencies regarding issues pertaining to students with ASD 4) To develop effective links with and enhance the knowledge of staff in non-profit community agencies supporting children and youth with autism spectrum disorders and their families ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

9 SSP-ASD What we do: Consultation Training Resource development Parent and Community education Connections for Students ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

10 Autism Spectrum Program Transition Classroom For children moving from IBI into full time school 6 month period Objectives: to help prepare each child for school placement by focusing on classroom routines; to teach children how to learn with fewer reinforcers; to imitate and to respond to peers Connections Joint initiative - Ministry of Children and Youth Services & Ministry of Education to provide student support to the education system for children being discharged from IBI to attend publicly funded school ASD consultants work with childs school team, incl. parents, to develop an educational plan based on ABA principles 6 month pre- and 6 month post- transition Autism Intervention Program School Support Program ©2009 Autism Spectrum Program, Childrens Hospital of Eastern Ontario

11 Total Clinical Outcomes Management (TCOM) Child and family needs and strengths are at the heart of service provision, and are considered in all transition activities Child and family characteristics are monitored in order to better manage transition outcomes Ongoing quality assurance is embedded in service planning Competing stakeholder perspectives and objectives are aligned in order to best serve the child and his/her family Standard child and family focused assessments drive decisions at multiple service levels (e.g., family, service, program, agency)

12 Primary Tenet of TCOM The primary tenet of TCOM is that effective services in complex child serving systems require a focus on a shared vision of the children and families receiving services. Complex systems require the collaboration of multiple partners each with different mandates, agendas, and priorities. The facilitation of communication among all system partners, including youth and families is necessary. Despite differences, all partners share a commitment to serving children and families. Accountability to the child and family is required between all partners at all levels

13 There are 3 basic ways to use a structured assessment: Family & Youth ProgramSystem (Community/Full system) 1. Decision Support What Next? Service Planning What is my treatment plan? Actions for areas of need and strengths. Eligibility Are these the right kids E.g.. IBI, ABA, Acute care, Residential care Resource Management Do I have the right number of services to support the children in the right area e.g. geo-mapping What will I fund? Staff skill mix 2. Quality Improvement How am I doing? What can I improve? Case Management & Supervision Monitoring of what is going on. Help to guide the case management or service – supervision guideline Accreditation Information required to complete our formal accreditation Transformation Can you evolve the system to be effective? How do I use the information to change system? i.e. gaps 3. Outcome Monitoring What is my review process? Service Planning & Celebrations This could be d/c or transition planning i.e. what are the next steps for this child. What do you now know that is effective and want to share. Celebration of this knowledge e.g. Transition classroom Evaluation Traditionally known as program evaluation or outcome monitoring (represents only 1/9 of what we can do with the information Performance Contracting Vast majority of us do not pay for a service that doesnt work! (e.g. house renovation, take out) This is not true in health care. Makes no sense to have an entire business no matter how poor the performance in this service. TCOM Grid of Activities TCOM Grid of Activities John Lyons, 2006

14 "The only man who behaved sensibly was my tailor; he took my measurement anew every time he saw me, while all the rest went on with their old measurements and expected them to fit me." (George Bernard Shaw)

15 CANS – A Communimetric Measure Action Level Key Needs: 0 - No Need 1 - Watch/Prevent 2 - Act 3 - Act Immediately/Intensively Strengths: 0 - Centerpiece 1 - Useful 2 - Potential 3 - None identified

16 CANS-Autism Spectrum Profile (CANS-ASP) Child and adolescent needs Life domain functioning Cognitive functioning Sensory/motor functioning Communication Co-morbidities Maladaptive behaviours Parent/caregiver needs and strengths Child/adolescent strengths Environmental strengths

17 CANS-ASP (partial) CHILD/ADOLESCENT DOMAINSNEEDS 0 = No evidence of problem - No need for action 1 = History - Watchful waiting & prevention 2 = Moderate need - action required 3 = Severe problem/need - Immediate/intensive action required LIFE DOMAIN FUNCTIONING 1 2 3 4 1. Family Functioning 2. Social Functioning 3. Temperament/Emotional Responsiveness 4. Eating 5. Sleeping 6. Elimination 7. Parent-Child/Adolescent Interaction 8. Academic Achievement 9. Academic Persistence 10. School Attendance 11. Classroom Behaviour 12. Non Classroom Behaviour 13. Special Education 14. Activities of Daily Living 15. Adaptation to Change 16. Transitions

18 How are we managing the information? Family & YouthProgramSystem Decision Support Service Planning Plan of care Eligibility Suitability for IBI, ABA, OT, SLP Resource Management Staff skill mix Community resources Quality Improvement Case Management & Supervision Psychologists, Senior Therapist AccreditationTransformation New system of care? Outcome Monitoring Service Transitions & Celebrations Evaluation program (service) Are we delivering a personalized service? Performance Contracting TCOM Grid of Activities TCOM Grid of Activities

19 Embrun/ PR / Rockland / Hawkesbury: 7.8% Cornwall / Stormont-Dundas-Glengarry: 8.7% Renfrew / Pembroke / Petawawa / Arnprior / Deep River: 7.8%

20 Percent actionable functioning needs for children on the waitlist

21 Percent of actionable cognitive, motor and communication need for children on the waitlist

22 Percent of actionable co-morbidities and risk behaviours for children on the waitlist

23 Percent of useful strengths for children on the waitlist

24 Contact Information Lise Bisnaire, Ph.D bisnaire@cheo.on.ca Heather Woltman hwolt031@uottawa.ca


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