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OAP Clinical Framework - Introduction

The Ontario Autism Program (OAP) of the Ministry of Children and Youth Services is fundamentally changing how behavioural supports and services are provided to children and youth with Autism Spectrum Disorder (ASD) and their families. A single continuum of individualized and flexible services will support the learning, wellness and development of these children and youth. This change must also be reflected in how individualized decisions are made about the interventions that children, youth and families receive. This Clinical Framework describes how clinical decision-making will be supported while promoting consistency of practice across the province. It is intended to be used in conjunction with the program guidelines for the new Ontario Autism Program.

Individualized, personalized services recognize the complex profile and learning needs of each child and youth with ASD, and current research supports this personalized approach.1,2 Getting the right services at the right time starts as a child or youth is referred to the OAP and is welcomed into the OAP entry point within their community. Flexible and responsive service is evident as the family begins to receive a series of interventions, moving along a continuum of evidence-based interventions, starting as early as infancy, continuing throughout their school years and through their transition to adult services and supports. During that time children will grow and learn; strengths, interests and needs will evolve and the continuum of evidence-based services will adjust to meet the changing goals of each individual.

A key aspect of clinical decision-making in the OAP is the principle of child-, youth- and family- centred services. Family-centred care is an approach to planning and delivering care that promotes collaborative partnerships between care providers, children, youth and their families.3,4,5 All decisions about supports, behavioural interventions and the coordination of services are made in partnership with the family and/or youth, and their priorities are at the heart of those critical conversations. For example, research indicates the need for clinicians to establish a supportive relationship with a child’s or youth’s caregivers and family as they design services that fit best with an individual family’s values and needs (e.g., cultural values, capacity, etc.).6 Therefore, a collaborative assessment and goal-setting process is a necessary step in family engagement. The OAP plays a critical role in supporting youth and families not only to make key decisions about their child’s services, but also to develop children’s and youths’ self-advocacy and self-actualization skills that they will call upon throughout their lives.

Evidence-based behavioural services and best practices play a fundamental role in the process of a youth’s and/or parent’s informed decision-making. Information given to parents and youth in clear and understandable ways is required to support an effective decision-making process and optimal outcomes.

Lastly, the OAP is not a program that can exist in isolation within a family’s community. The enduring, often lifelong support of extended family, friends, other parents of children with ASD and community members cannot be underestimated. Medical, educational and other services for people with special needs, as well as community programs also play vital roles in the lives of children and youth with ASD. As directed by the family, the coordination of services and collaborative partnerships that fit with the family-centred care approach are an expectation within the OAP Clinical Framework.

This document provides the clinical framework to be used in the OAP. It was developed to assist families across the province of Ontario to understand how needs are assessed, how intervention is planned, how progress is reviewed, and how transition planning is undertaken in the OAP. Within this framework, children and youth with ASD, their families and caregivers will receive supports and behavioural intervention, including education and training, to ensure best outcomes.

The Clinical Expert Committee (CEC) prepared this clinical framework by gathering information regarding how behavioural interventions and other supports could best be delivered. Families, clinicians, educators and behavioural service providers from across the province participated in focus groups to help the committee consider the skills, needs, goals, and hopes of children and youth with ASD and their families as the new OAP is being developed. In addition, parents were invited to provide input via an online survey. Input from clinicians who are currently involved in treatment planning with children with ASD in Ontario was solicited to participate in a clinical decision-making simulation study to identify key information used by clinicians in the clinical-decision making process. All this information was integrated with evidence from relevant literature that could inform the development of this clinical framework. Detailed information about each of the three consultation methods can be found in Appendix A.

The current document is the first phase in the development of a framework that will evolve based on feedback/validation from various OAP stakeholders over time, as well as from the data from evaluations of the first group of children and youth who will enter the OAP in June 2017. Initial evaluation of this framework will take place between September 2017 and January 2018. The evaluation will identify any gaps in knowledge essential to understanding family needs, and the information or further assessments that may be required to understand the most effective intervention for the child or youth. This feedback will be used to gather information regarding any changes required to support a comprehensive intervention planning process, and the framework will be adjusted as necessary before implementation of the full OAP in Spring 2018. This framework will then continue to evolve over time, based on evaluation over the course of its implementation, allowing for further clarification and refinement of an OAP Clinical Framework that best meets the needs of children and youth with ASD and their families in Ontario.

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Key Terms and Definitions

Applied Behaviour Analysis (ABA): An applied science, based on the principles of learning and behaviour, which uses specific methods to change behaviour. ABA is supported by a body of scientific knowledge and research, established standards for evidence-based practice, distinct components for service provision, recognized experience and educational requirements for practice, and identified educational requirements in universities.

Behaviour Plan: A detailed description of the recommended behavioural intervention developed by an OAP Behavioural Clinician. Behaviour Plans share common components and can vary considerably depending on the nature of the behaviours being addressed and the intervention modality.

Autism Spectrum Disorder (ASD): A neurodevelopmental disorder with qualitative differences and impairments in reciprocal social interaction and social communication, combined with restricted interests and rigid and repetitive behaviours.

Evidence-Based Practice (EBP): The integration of clinical expertise, client values, and the best research evidence into the decision-making process for client care.

Family: Families can include parents, caregivers, grandparents, siblings and other relatives.

OAP Behavioural Clinician: General term used that encompasses any behavioural clinician of the Ontario Autism Program. Further information is provided in the OAP program guidelines.

OAP Family Support Worker (FSW): An individual assigned to a family to assist with needed service and program navigation, supports and planning, including the development of the OAP Family Service Plan.

OAP Family Service Plan (FSP): An evolving plan that describes the services and supports that a family and their child need and agreed upon next steps. It is developed by the family with an OAP clinician, and Family Team if applicable.

OAP Family Team: Coordinates and aligns the broader services a child/youth and their family may be receiving with their OAP behavioural services on an ongoing basis. It also promotes consideration of the whole child/youth. A family team is optional, based on the family’s choice, and its membership is determined with the family/youth.

Family Team Lead: An individual chosen from a Family Team to support team function, scheduling and communication.

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Acronyms

ABA - Applied Behaviour Analysis

ASD - Autism Spectrum Disorder

BCBA - Board-Certified Behaviour Analyst

CANS - Child and Adolescent Needs and Strengths Measure

CEC - Clinical Expert Committee

DFO - Direct Funding Option

DSO - Direct Service Option

EBP - Evidence-Based Practice

ECE - Early Childhood Educator

FSW - Family Support Worker

FSP - Family Service Plan

IBI - Intensive Behavioural Intervention

MCYS - Ministry of Children and Youth Services

OAP - Ontario Autism Program

ONTABA - Ontario Association for Behaviour Analysis

RAPON - Regional Autism Providers of Ontario

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