Bitmaker Labs Program Volunteer Training Autism Ontario August 2014.
The Ontario Autism Program Recommendations
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The Ontario Autism Program Recommendations Presented by the Ontario Au2sm Coali2on December 7, 2016 Copyright 2016. Ontario Au2sm Coali2on
Transcript of The Ontario Autism Program Recommendations
TheOntarioAutismProgramRecommendationsPresentedbytheOntarioAu2smCoali2onDecember7,2016
Copyright2016.OntarioAu2smCoali2on
WhatisASD?• Neurodevelopmentaldisordercharacterizedbydifficultyinsocialinterac2on,verbalandnon-verbalcommunica2onandpresenceofrepe22vebehaviourand/orrestrictedinterests
• Lifelongdisability• Notwoindividualsarethesameandtheimpactonfamiliesanddailyfunc2oningvary
• Severityofsymptomsvary…thereforenotallindividualswithASDrequirethesameintensityofservicesandthequalita<venatureoftheservicesmayvaryaswell
• Nocure,howevertherapeu<cinterven<onscandrama<callychangethequalityoflifeforthoselivingwithASD
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WhatisABA(AppliedBehaviourAnalysis)• Themostwelldocumentedandempiricallysupportedtherapeu2cinterven2onforASDisABA
• Scienceofbehaviourfocusingon“analysis,design,implementa2onandevalua2onofsocialandotherenvironmentalmodifica2onstoproducemeaningfulchangesinhumanbehaviour”(ABAGuidelinesforASD,BACB)
• SupportedbydecadesofresearchtoimprovesymptomsofASDandhasevolvedoverthedecadestohaveabroaderscopeofprac2ceandprocedures
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TheOntarioAutismProgram:Mission• Toprovideempiricallyvalidatedtherapeu2cservicesandsupportsforchildren,youthandadultswithASDandtheirfamiliesthatarebasedoneachindividual’sandfamily’sneedsandul2matelyhelpimprovethequalityoflifefortheindividualandtheirfamilies
• ToprovideabroadscopeofABAservicesandsupportstotheparentsofindividualslivingwithASDbasedontheirneedswiththeaimofimprovingtheirabilitytoprovidesupportandfostergreaterindependentlivingforindividualswithASD
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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)
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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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
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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Step2.IntakeandApprovalbyMCYSRegionalOfIice• FileassignedtoMCYSStaff“Coordinator”• Coordinatordetermineseligibilitybasedontransparentadministra2vecriteriaNOTclinicalcriteria(noreassessmentisrequiredandnoexclusioncriteriabeyondanASDdiagnosis)
• Ifindividualapprovedforservices,MCYSStaffCoordinator:• Providesinforma2ontofamiliesregarding:
• OnlineregistryforServiceProviders• Communityresourcesforfamilies• Onlinewebinars(e.g.whatisASD,whatisABA)
• Assignscasemanagertoindividual/family
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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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)
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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
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ApprovedTeam
BCaBA
BCBAST
IT/RBTIT/RBT
ClinicalPsychologist/PsychologicalAssociate
(RHP)CIC
*RHP=RegulatedHealthProfessional.RHPmayalsobeaBCBA.
Occupa2onalTherapist(RHP)
SpeechLanguagePathologist
(RHP)
PhysicalTherapist(RHP)
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Note:SometeamsmaynothaveaBCBASometeamsmaynothaveaBCaBASometeamsmaynothaveaRBTCIC=ClinicianinChargeST=SeniorTherapistIT=InstructorTherapist
SampleProgram• For40hourperweekof1:1ABAProgram
• 40hoursofIT2me(1:12mewithindividual)• Minimumof8hoursofsupervisionbySeniorTherapist:supervisionofITs,reportwri2ng,developmentoftreatmentplan
• NOTE:presentcapacitywouldnotenable8hoursperweekofsupervision.Theremustbeflexibilityandfluidityascapacitybuilds
• ClinicalPsychologist/PsychologicalAssociatefunc2onsasClinicalSupervisorduetotheirexper2seinthedevelopmentalapproachtoservicedelivery(thisispresentlyaconten<ousargumentbetweenBCBAsandClinicalPsychologists)
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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• 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
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FeeGuidelines-UseofFeeScheduletoEstablishRates: • Feeguidelinesperdiscipline:
• IT• BCaBA• BCBA• ClinicalPsychologist• PsychologicalAssociate
• Associa2onofprofessionalswhocanprovidesugges2onsforfeeschedule(similartoFSCO,OntarioPsychologicalAssocia2on,OASIS,OntarioPhysiotherapyAssocia2on)
• Nofeescheduleatpresentbutcanbedeveloped• DirectpaymenttoserviceprovidersIDEAL
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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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
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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Step6.Transition• Transi2onto“Comple2onofService”orTransi2ontoDevelopmentalServiceOntario(atage18years)
• Decisiontotransi2on/dischargemadebyclinicaljudgment
• Transi2ontoComple2onofServiceonlyifoneofthefollowingcriterionaremet:• Evidenceofmasterygoalsoftreatment• Individualnolongermee2ngdiagnos2ccriteriaforASD• Frequent/chronicmissedsessions• Lackofprogressongoalsacrossmul2plereviewperiods• Familyini2ateddischarge• Unresolvedconcernsrelatedtotreatmentbetweenfamilyandserviceprovider(BACB,2014;CalABA,2011)
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FlowofServices1.Referralfor
MinistryFundedABAServicestoMCYSRegionalOffice
2.IntakeandApprovalbyMCYSRegionalOffice
3.Selec2onofProviderand
SubmissionofServicePlan
4.ApprovalofServicePlanbyMCYS
RegionalOffice
5.ABAServiceDelivery
6.Transi2ontoMCSSDevelopmental
ServiceOntario(at18years)
6.Transi2ontoComple2onof
Service
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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
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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)
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