You are hereSkip Navigation Links

SECTION 2: About the Independent Clinical Review Process

This section provides key information about the ICR including, but not limited to, the goal of the process, its scope, the method used to conduct reviews, and timelines. It offers a concise snapshot of the process. A more detailed overview of the stages and key roles in the process can be found in section 3, Overview of the Independent Clinical Review Process.

Goal

The ICR offers families and their children the opportunity to have key components of their OAP Behaviour Plan reviewed by a team of independent Clinical Reviewers.

Scope

The key components of an OAP Behaviour Plan that can be reviewed, as outlined in the OAP Clinical Framework, are:

  1. Domain(s) to be addressed;
  2. Skill(s) to be increased;
  3. Behaviour(s) to be decreased;
  4. Planned intervention approach, including intensity and duration; and,
  5. Behaviour goal(s).

Families can request a review of one or more of these key components of an OAP Behaviour Plan.

The ICR is not a second opinion, and does not involve a clinical re-assessment of a child in or entering the OAP. Concerns about how a Behaviour Plan has been implemented or reviews of funding allocation decisions are out of scope for this review process.

Method

As a prerequisite to the ICR process, families who are dissatisfied with their child’s OAP Behaviour Plan must notify their Direct Service Option (DSO) or Direct Funding Option (DFO) OAP service provider. The provider must work with the family through their internal review process to try to resolve any differences in perspective. If the family remains dissatisfied with the outcome of the OAP provider’s internal review, they can request a review of their child’s OAP Behaviour Plan through the ICR.

The ICR is a paper-based review of key components of a child’s OAP Behaviour Plan, conducted by two clinicians, based on case file materials. The Clinical Reviewers are provided with the perspective of the family requesting the review, giving them invaluable context for the review.

Case File Materials

Case files contain all the relevant materials related to a child in the OAP. A comprehensive case file will contain materials that are both clinical and non-clinical in nature. Decisions rendered by the ICR stem from a thorough review of a child’s case file materials by Clinical Reviewers.

For the purposes of the ICR process, all case file materials should include, but not be limited to, the following information:

Key Parties in the ICR

The role of key parties in the ICR includes:

Overview of the Review Committee

Review Committee Members # Assigned per Review Committee Qualifications Role in the Review Process
A. Family Representative 1 member
  • Parent, guardian or primary caregiver of a child with ASD.
  • Familiar with autism services for children and youth in Ontario.
  • Helps to provide a clear understanding of the family’s and child’s perspectives in the review process.
B. Clinical Reviewers 2 members: 1 Board Certified Behaviour Analyst; and 1 Psychologist/ psychological associate
  • Must meet the required qualifications for a Clinical Supervisor in the OAP or be working towards achieving them.
  • Familiar with autism services for children and youth in Ontario.
  • Responsible for the clinical review of the case file and decision-making.

A. The Family Representative
Family Representatives are parents, guardians or primary caregivers of children with ASD, who are hired and trained by the ICR Coordinator to help communicate families’ perspectives about their children’s OAP Behaviour Plans to the review committee. Each family in the review process is assigned a Family Representative.

As a member of the Review Committee, the role of the Family Representative is to have a conversation with the family about their concerns, and to help ensure that the family’s and child’s perspectives are accurately presented to the Clinical Reviewers responsible for making a decision. They are not involved in the clinical review of the child’s case file, or making the ICR decision, and they do not play an advocacy role for families or their children in the review process.

B. The Review Committee Clinical Reviewers
Decision-making in the ICR is guided by the expertise and experience of two clinicians who are familiar with autism services for children and youth in Ontario. Every Review Committee includes one Board Certified Behaviour Analyst (BCBA) and one psychologist/psychological associate. The reviewers must meet the required qualifications for the position of a Clinical Supervisor, as outlined in the OAP Guidelines, or be working towards achieving them.

Family Engagement

Active engagement of families and their children throughout the OAP process as set out in the OAP Guidelines and the OAP Clinical Framework, is essential to building positive relationships, outcomes, consensus, and preventing disputes.

The OAP’s family-centred approach, and its emphasis on family engagement, are designed to help foster a cooperative, collaborative relationship between families and service providers. Families and OAP providers should take advantage of key mechanisms built-into the OAP, such as Family Support Workers, Family Service Plans, and Family Teams.

If families are unable to reach consensus about their child’s Behaviour Plan with their OAP provider, the ICR has measures in place to support family engagement in the independent review process. This includes, as noted above, having a Family Representative work with the family directly so that their perspective is clear and understood in the review process. Should they choose to do so, families also have the option to participate in a conference call with Clinical Reviewers where the family perspective is outlined.

Peer-Reviewed Decision-Making

A decision about whether to accept a Behaviour Plan or send it back to the OAP Clinical Supervisor for revisions and/or additional information is the outcome of a thorough review of a child’s Behaviour Plan and the contents of the child’s case file materials in the context of evidence-based practice.

In undertaking a review, the Clinical Reviewers evaluate key components of a child’s Behaviour Plan against the materials in the child’s case file to determine whether or not the plan is consistent with the case file materials and evidence-based practice. If the Clinical Reviewers find that the child’s case file materials and evidence-based practice do support the content of the child’s OAP Behaviour Plan, the Clinical Reviewers accept the plan as is.

If the Clinical Reviewers find that the child’s case file materials and evidence-based practice do not support the content of the child’s OAP Behaviour Plan, they will send it back to the Clinical Supervisor to be revised and/or for additional information. The reviewers highlight areas of concern in the plan, and indicate where greater clarity and/or data is required. As this is a paper-based review process, Clinical Reviewers provide feedback on areas of inconsistency to be addressed by the Clinical Supervisor, however they do not make specific clinical recommendations about what services a child should receive, the number of service hours or the duration of services.

Decisions rendered at the conclusion of the ICR process are final.

Timelines

Families requesting a review will receive a decision from the ICR no later than 45 business days from the date they submitted the ICR Family Request Form to their OAP service provider. 3

Autism Supports and Services

Families going through the ICR process may choose to receive services based on the Behaviour Plan being reviewed, and/or receive other OAP services as available.

French Language Services

In compliance with the French Language Services Act, all materials related to the ICR are available in both English and French. Moreover, families can indicate whether they prefer to have a review undertaken in English or French on the Family Request Form.

An Accessible Review Process

The ICR process strives to provide culturally sensitive services to all families. It aims to respond to the service needs of Francophone children and their families, and remains aware that distinct approaches may be required to address the needs of First Nations, Métis, Inuit and urban Indigenous children.

back to top