OAP Clinical Framework - Appendices

Appendix A: Methods

  1. Parent/Youth, Clinician and Educator Stakeholder Consultations

    Stakeholder focus groups took place from November 2016 to March 2017. The purpose of the consultations was to document the advice, experiences, perspectives, and priorities from as many stakeholders across the province as possible. This wide gathering of information was done to ensure recommendations to the Minister about the OAP reflected the advice of children and youth, their families and their support and service providers, and took into consideration not just the individual skills that a child/youth can improve, but also their ability to participate as fully and as independently as possible in all their settings. Importantly, we wanted to ensure that the priorities of children and youth with ASD and their families were well understood.

    Each meeting was arranged with the intention of having between 10 and 12 stakeholders present to allow for fulsome participation. Most meetings achieved this target number, with a small number of groups having fewer than 10 participants and others with 15-20. Stakeholders included parents, youths, clinicians (e.g., members of the Regional Autism Providers of Ontario Network, the Ontario Association for Behaviour Analysis, the Independent Review Mechanism, Direct Funding Option providers, occupational therapists, speech language pathologists, physiotherapists, pediatricians), and educators (e.g., early childhood educators, resource teachers, teachers, educational assistants, school-based ASD and ABA specialists, superintendents, principals). Three parent/family and two school board focus groups were also conducted in the north.

    Youth focus groups discussed the types of goals they each have achieved, as well as supports that might benefit others. Parents were asked questions about the best ways for interventionists to get to know their children, how to decide what to work on, and optimal communication with the clinical team. Focus groups of clinicians discussed four main areas: information sharing within and outside of the OAP; factors and tools that should be considered when making clinical decisions within the OAP; and ways to create an integrative team that includes caregivers and service providers. Minutes from each meeting were analyzed for common themes.

  2. Community Stakeholder Consultation and Ontario Parent Survey

    Input from parents was solicited using an online survey. The survey was sent to parents within the networks of stakeholder groups who were invited to participate in our community-stakeholder consultations (e.g., Autism Speaks, Autism Ontario, South Asian Autism Awareness Centre, the Ontario Autism Coalition, and La Société franco-ontarienne de l'autisme). The Société franco-ontarienne was not able to attend but did circulate the survey. The survey consisted of 4 questions that addressed the general strengths and needs of a child/youth with ASD and how clinicians should work with a family to consider these factors.

    The survey was open for input between March 6, 2017 and March 17, 2017. A total of 467 individuals from across the province participated in the survey. A clear majority of participants were parents with a few individuals self-identified as well as teachers or clinicians.

  3. Intervention Planning Framework Study

    The CEC worked closely with RAPON to identify clinicians in all regions across the province, including both Direct Service Option and Direct Funding Option providers, in three professional groups (i.e., psychologists/psychological associates, Board Certified Behaviour Analysts, and speech-language pathologists). Clinicians who self-identified as having dual-credentials (e.g., SLP and BCBA certifications) were coded according to their primary clinical affiliation.

    Clinicians (N = 83) from across the province volunteered several hours of their time to complete these surveys. There was a strong representation from different sectors, professions, and treatment setting experiences. The high rates of participation make it clear that clinicians in Ontario value the opportunity to guide system-level change to better support children and youth with ASD and their families.

    Clinicians were given nine different case vignettes that included a comprehensive description of the bio-psycho-social status and history, detailed cognitive, developmental, and health information about individuals with ASD (i.e., preschool, school-aged, and youth) and their families/caregivers. Clinicians were then asked to (a) determine the ‘level of support needed’ for each individual (i.e., support needed vs. substantial support vs. very substantial), and (b) identify the specific domains (e.g., communication, school readiness, etc.) that they saw as relevant to that individual's needs.

    Key information identified as particularly important to clinicians in the clinical-decision making study included that there was a robust pattern in how clinicians valued the “whole child and family story/ vignettes” to help in the intervention design process (e.g., CANS and story). Other information that was helpful included a child’s age, diagnosis, child’s profile of strengths and needs, cognitive and adaptive profile, details about their social and communication skills, details and context about problem behaviour, current family stressors, family’s barriers and capacity to participate in interventions, and information/communication with school staff.

    Clinicians as a group consistently assigned children/youth with ASD into three defined levels of support. These results support the feasibility of a standardization component in the OAP.

    A range of intervention domains were identified for each child/youth. When asked to endorse the "domains" (e.g., communication, emotion regulation, etc.), clinicians provided response patterns that cut across all three "levels of support needed". In other words, the idea that "more severe" cases require a wider range of supports while "less severe" cases require a more limited range of support was not supported by the data.

Appendix B: Outcomes and Guiding Principles for the Ontario Autism Program Developed by the Ontario Autism Program Advisory Committee

Ontario Autism Program Outcomes

Child, Youth and Family Outcomes

Systems Outcomes

The Ontario Autism Program will provide services that are:

Ontario Autism Program Guiding Principles

Child, youth and family centered services: Children, youth and families are partners and are actively engaged in intervention planning. Evidence-based services are delivered according to a relevant assessment of a child or youth’s needs, strengths and interests and the family’s concerns and priorities. Families will be supported throughout the decision-making process. Informed choice is a key element.

Coordinated and collaborative: Intervention will be integrated and coordinated with other services that a child, youth or their family may be receiving. Families will experience a high degree of inter-professional partnership with mechanisms in place to support information sharing and collaboration amongst services and the community. Collaboration will take place among provincial ministries to support provision of coordinated services.

Flexible and responsive: Children, youth and their families will receive timely and individualized services in accordance with their needs, strengths and goals. The approach to intervention will be guided by an individualized service plan, developed in partnership with the family. Services will be flexible, proactive and continually responsive to the child, youth and families’ needs, recognizing that these needs change over time.

Available and accessible: Children and youth and their families can access the services they need close to home. Services are responsive to cultural, social, geographical and economic diversity and language needs of children, youth and their families. Entry into service will be straightforward and easy to navigate through a single entry point.

Transparency: Decisions regarding access to and provision of service will be transparent to families and other service providers, and information will be shared appropriately.

Continuous quality improvement: Approach to service delivery is outcome oriented and evidence-based. Services are flexible to be responsive to changing evidence and practice, and are accountable through continuous evaluation and monitoring. Capacity-building for families and service providers that incorporates evidence-based strategies and competency-based improvement is an essential component of service delivery.

Equitable and fair: Families with children and youth with autism have an equal opportunity to access equitable services that respond to their individual needs.

Free from conflict of interest: Clinical decisions will be made in the child or youth’s best interest.