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.
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)
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
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
"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)
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
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 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
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