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ADDENDUM

CHANGES TO THE FRENCH VERSION OF THE AUTISM INTERVENTION PROGRAM GUIDELINES

Effective May 2011

The following addendum outlines a change to the French version of the Autism Intervention Program (AIP) guidelines to ensure that the French version of the guidelines is interpreted the same that the English version is interpreted and to prevent the eligibility criteria for the program being misinterpreted. This change should be read in concert with the corresponding section of the AIP guidelines.

On page 7 of the AIP guidelines, section 2.1, replace:

"avoir été diagnostiqués par un médecin ou un psychologue comme étant atteint de l'autisme ou d'un trouble du spectre autistique qui se situe à l'extrémité supérieure du spectre autistique."

with :

"avoir reçu d'un médecin ou psychologue un diagnostic d'autisme ou d'un trouble du spectre autistique dont les symptômes sont d'intensité élevée."

NOTICE
AUTISM INTERVENTION PROGRAM GUIDELINE REVISION

Effective as of January 1, 2007

On January 18, 2007, the Ministry of Children and Youth Services announced a plan to make intensive behavioural intervention (IBI) services immediately available to 225 more children currently on Autism Intervention Program waitlists.

For families selecting service delivery through the Direct Funding Option, the Autism Intervention Program Guidelines (August 2006) are being amended to expedite approval of private providers.

The current guidelines require approval of a private provider on a case-by-case basis. Effective January 1, 2007, the regional autism service provider may pre-approve existing and new private funding arrangements where the private provider:

Date of Revision: February 12, 2007

Autism Intervention Program
Program Guidelines

Ministry of Children and Youth Services

Revised August, 2006

Table of Contents

  1. Purpose of Guidelines; Goal, Objectives and Components of Program
  2. Access to the Program
  3. Child and Family Support Services
  4. Intensive Behavioural Intervention
  5. Transition Services
  6. Program Delivery

1. Purpose of Guidelines; Goal, Objectives and Components of Program

1.1 Purpose of the Guidelines

These revised program guidelines govern the delivery of intensive behavioural intervention and associated services to children with autism by the nine Regional Program Providers delivering the Autism Intervention Program.

1.2 Program Goal and Objectives

Goal

The goal of the program is to provide high quality, evidence-based intensive behavioural intervention (IBI) and associated services, such as Child and Family Supports and Transition Services, that are coordinated with other services that children and youth with autism and their families are receiving.

Objectives

The objectives for the child with autism are to:

The objectives for the program are to:

Regional Programs are expected to integrate with and build on the success of other services and supports available to children and their families locally and regionally. They will link and coordinate with other programs and services such as:

Policies and procedures developed for the program will be consistent with local systems of services under Making Services Work for People, Healthy Babies Healthy Children, and Preschool Speech and Language programs.

Regional Programs are expected to provide services in French in designated areas of the province, as described in the French Language Services Act.

1.3 Program Components

The Autism Intervention Program will operate within the geographic boundaries of the nine regional offices of the Ministry of Children and Youth Services and may provide, as appropriate for the child and family, the following:

Figure 1

The flow of service components is illustrated by the decision tree below:

Application received by Regional Program
Eligibility Determination by Regional Program
Ineligible
Referral to other Community Services
File Closed by Regional Program
Eligible
Child and Family Support Services delivered by
Regional Program
Intensive Behavioural Intervention intensity, setting &
duration determined by Regional Program
IBI Regional Program IBI Direct Funding
Transition Planning by private provider and Regional Program
Transition Supports delivered by Regional Program

2. Access to the Program

2.1 Referral

Through Making Services Work for People, Healthy Babies Healthy Children, Ontario Early Years Centres or Preschool Speech and Language programs, most communities have identified point(s) of access for services. The Autism Intervention Program should use these points of access for intake, whenever appropriate and possible. Depending on the local service system, the program may develop a suitable alternate intake process.

Criteria for Referral

Referrals will be accepted for children who meet all of the following eligibility criteria:

In addition, signed parental consent for the Regional Program to access and/or release any assessment results and reports is required.

Referral or application to the program does not constitute a commitment for intensive behavioural intervention. Before a child begins receiving IBI services, the Regional Program must conduct an eligibility assessment. This assessment should not unnecessarily duplicate other assessments. If the assessment results suggest the child has a different or very mild form of developmental disorder, or that a different approach to intervention would better meet the needs of the child and family, appropriate referrals will be made.

2.2 Eligibility Determination

Autism can be viewed as a continuum or spectrum, known as autism spectrum disorder. The disorders on the spectrum vary in severity, but have certain common core symptoms.

This initiative is intended to provide services, including intensive behavioural intervention, for children with autistic disorder or a disorder considered to be towards the more severe end of the spectrum (see Figure 2).

Figure 2: Severity of Autism Spectrum Disorder

More Severe Moderate Less Severe
<————————————————————————————————————————————————————>
Autistic Disorder PDD-NOS Asperger's Disorder
Atypical Autism
Eligible for IBI Referral to other services
<——————————————————— ———————————————————>

Clinical staff will review assessment information provided through the referral process to determine eligibility for IBI. When the Regional Program accepts a new referral to the program, it should identify if there are existing recent assessments for the child, whether appropriate assessment tools have been used, and if these have been completed by qualified health professionals. The assessment to determine eligibility to receive IBI will occur within four to six weeks after a referral has been received.

If additional information is required, Clinical Directors or Supervising Psychologists of Regional Programs will use the same specific core tools. The Regional Program's eligibility determination assessments will not duplicate other assessments. Clinical Directors, as a group, may determine additional, relevant and appropriate tools to be used provincially. It is important to note that not all children will meet the eligibility criteria. Families of children who do not meet the eligibility criteria will be informed and referred to other appropriate services.

3. Child and Family Support Services

All families of children who meet the eligibility assessment for the program will be offered support services while waiting for intensive behavioural intervention to start. Families will be offered training specifically to help ready their child for IBI, to promote skill development and foster integration into small groups. Building on the best practices that already exist across the province, these services promote positive outcomes and may include the following:

3.1 Wait List Management

Every effort will be made to effectively manage and minimize waiting lists. A consistent wait list management strategy based on date of referral and geography will be used.

The assessment to determine eligibility to receive IBI services will be conducted within four to six weeks after the referral is received. Families, whose children are found to be ineligible, are to be provided with information about other services available in the community.

Each Regional Program must provide Wait List Coordination through a designated position or assignment of the function to other staff. Wait List Coordination is to:

The wait list for service (after eligibility for the program has been determined) is to be chronological with the date of initial referral to the program used as the reference date. Date of initial referral is defined as the point of contact at which the provider begins to collect information about the child. Geography is a factor to be used to recognize the service communities within a region.

4. Intensive Behavioural Intervention

The Ministry of Children and Youth Services contracts with service providers (Regional Programs) in the nine regions of the province to provide intensive behavioural intervention.

Before a child starts receiving IBI services, the Regional Program must conduct a full assessment to determine eligibility and, where there is eligibility, intensity, setting and duration.

4.1 Assessment

Diagnostic and assessment information provided in the referral process will be used to determine eligibility, intensity, setting and duration for intensive behavioural intervention. If the information is not adequate or available, additional assessments may be required or administered. Regional Program assessments for intensive behavioural intervention include the following components:

Periodically, Regional Programs, in consultation with the Ministry of Children and Youth Services, may revise the standardized assessments used based on experience and best practices. All Regional Programs must use certain tools (e.g., Diagnostic and Statistical Manual - IV criteria, Childhood Autism Rating Scale (CARS) and Vineland Adaptive Behaviour Scale) to reduce clinical variation, to allow for continuous quality assurance monitoring and to form the basis for outcome evaluation of the overall program. These are also used to demonstrate and measure progress in children.

Prior to initiation of service, the Regional Program will conduct an assessment of family resources, strengths and needs. This may include measures of stress and family functioning.

Responsibility for Assessment

It is the responsibility of the Regional Program to determine eligibility, intensity and setting of a child's intensive behavioural intervention. This applies to both children whose families choose the direct funding option and private service delivery, or regional program service delivery. Once eligibility has been determined and the service delivery option selected:

  1. The program provider (regional or private) completes baseline skill assessments for the child; and
  2. The program provider (regional or private) evaluates progress of the child at regular intervals, minimally every six months.

If the Regional Program determines that a child is ineligible for intensive behavioural intervention, and that a different approach to intervention would better meet the needs of the child, referrals to other community supports and/or programs will be made.

Determining Service Intensity, Setting(s), and Duration

The behavioural intervention should be provided at an appropriate level of intensity in appropriate setting(s) for an appropriate period of time, depending on the child, family and community. Clinical determinations of service intensity, settings and duration are designed to facilitate the child's goal attainment. There is no clear-cut research-based decision-making process for determining optimal intensity, setting(s), or duration of intervention. These are essentially clinical decisions, which should be based on a number of factors described below.

The recommended service intensity, duration and setting will be included in the child's Individual Program Plan. At regular intervals (minimally, every six months), the clinical team and the family will review the plan and, if indicated, adjust service intensity and setting(s) to meet the child's changing needs.

Intensity

"Intensity" is more than simply the number of hours a child spends in intervention. More importantly, it depends on the quality of intervention provided during those hours.

Children may be eligible to receive a number of hours, to a maximum of 40 hours per week, of intensive behavioural intervention. While it is expected that the number of hours will generally fall within the 20 to 40 hours per week range, the exact number of hours is determined by means of a clinical assessment and based on the individual goals for each child. With approval by the Clinical Director/Supervising Psychologist, services delivered by other professionals or qualified paraprofessionals trained in IBI/ABA may be included in the total number of service hours if the service supports achievement of the child's clinically determined goals.

Hours will be provided within available resources of the Regional Program. Service hours lost as a result of unavailability of staff or child cannot be "banked" and made up at a later time. Every effort will be made to minimize service hours that are lost as a result of unavailability of staff.

In determining the intensity of each child's program, the Clinical Director or Supervising Psychologist should consider:

Setting(s)

Effective early intensive behavioural intervention programs can be delivered in a variety of settings, including:

Regional Programs are expected to use a variety of settings based on clinical decisions, made in consultation with parents, to meet the child's needs. The Clinical Director or Supervising Psychologist will determine if the home is an appropriate setting for service. If the home setting is selected, a parent or other responsible adult must be in the home during intensive behavioural intervention sessions.

In determining the setting(s) of each child's program, the Clinical Director or Supervising Psychologist should consider, in consultation with the child's parent(s) and appropriate staff:

Duration

A child's service needs will change over time. The Clinical Director/Supervising Psychologist will review the child's progress at regular intervals, using information from service providers and the parents, and will modify the child's Individual Program Plan accordingly. This may result in increased or decreased intensity.

As a child is identified as approaching transition from the program to school or other community settings, various additional assessments may be undertaken. A discharge assessment is required.

4.2 Individual Program Plans

Regional Programs are responsible for working with families to develop an Individual Program Plan for every child who is eligible to receive IBI and will receive service through its program. The regional program will also review and approve Individual Program Plans developed by private providers for children receiving IBI through the direct funding option.

The Individual Program Plan will describe the targeted goals for the services the child receives, guide his/her program and link the child and family to the range of appropriate community services. Regional Program staff will review the child's Individual Program Plan at regular intervals, minimally every six months, and modify or adjust it based on the child's progress.

The type of community services that children and families need will vary. Service providers in the community, with parental consent, may be called upon to advise on and participate in elements of a child's Individual Program Plan. Some of these may include:

Regional Programs will develop an Individual Program Plan, in concert with parents of children eligible for intensive behavioural intervention through its program. The Plan will be developed prior to or as intensive behavioural intervention services are initiated.

The Individual Program Plan:

When an Individual Program Plan includes additional services beyond those provided directly by the Regional Program, the program will assist families to apply for appropriate services through existing mechanisms in their communities. Regional Programs must make sure that all parties, including families, understand who is responsible for service coordination and direct families to ancillary support material.

4.3 IBI Services

For those eligible, the Regional Program and private providers offer intensive behavioural intervention which is based on the principles of Applied Behaviour Analysis (ABA), a scientific approach that describes a method to change behaviour and measure the resulting change.

The standards for intensive behavioural intervention are derived from research findings, expert opinion, and clinical practice guidelines developed in other jurisdictions.

Regional Programs are required, according to their service contracts, to provide high quality intensive behavioural intervention services.

Regional Programs and private providers shall deliver IBI services that:

Programs should deliver IBI services in a variety of settings to maximize generalization, maintenance, independence, and flexibility in children's behaviour and skills, from the beginning of service. IBI services will teach functional, relevant skills. Program deliverers will record children's behavioural responses and monitor the responses. Content will be based on the most current scientific evidence available for efficiency, safety and appropriateness.

Teaching methodology will use an ethical, positive approach to any serious behaviours (e.g., self-injury, aggression), based on a comprehensive biopsychosocial assessment, including but not limited to functional analysis; in accordance with Ministry standards and other applicable ethical and professional guidelines.

Regional and private programs do not provide BEHAVIOURAL services that use unproven or experimental approaches.

Regional Programs and private providers will, when children are eligible, provide INTERVENTION services, which:

5. Transition Services

There are two components of Transition Support Services: transition planning and transition supports. Both these services are provided by the Regional Program. It is the expectation that families who choose the direct funding option will contact the regional program at least six months prior to the child's transition to school and/or community agency if they are looking for transition support services.

5.1 Transition Planning

Good transition planning facilitates the integration of children into new environments. Transition planning should begin early and be part of each child's Individual Program Plan. Each child will have a transition plan that reflects individual strengths and needs. The plan should be integrated with other service providers involved with the family and existing community transition processes.

The following describes the steps Regional Programs, schools, community agencies, families and program staff should take to support smooth transitions.

Laying the Groundwork

The Regional Program should meet with community partners (e.g. child care) and school boards in its catchment area to discuss:

To help school boards plan special education services for children with autism, Regional Programs should, in accordance with appropriate freedom of information rules and confidentiality considerations, offer to provide school boards and community stakeholders with regular updated statistics on the number of children receiving services from the Regional Program including:

Planning Ahead

Most of a child's transition planning takes place long before the child leaves the Regional Program and/or direct funding option and should include the following steps:

5.2 Transition Supports

Transition planning will complement the entry to school planning provided through the Ministry of Education. To provide limited ongoing support to the child and family through the first year of school, the Regional Program will make transition supports available for up to twelve months following discharge from the intensive behavioural intervention program to school.

Ongoing Support

During the 12 months following discharge, transition supports provided to the child may include the following:

The Regional Program may be available, upon request of the principal, community partners and the parents, to provide consultation and support to the family and the school / community team by:

Families, who choose not to receive Transition Support Services immediately following their child's discharge, may become involved at a later time, within the 12-month window. For families who become involved later, services will only be available until 12 months post-discharge from intensive behavioural intervention.

Transition Support Services may be discontinued prior to 12 months, if based on consultation with the family and school, the Regional Program determines the support is not required or is no longer of benefit to the child or family.

5.3 Sharing Information

Any exchange of information must be done in accordance with privacy legislation and appropriate regard for confidentiality. The Regional Program will work with the family, school board and community partners within the context of privacy legislation, to establish a protocol for sharing information. The protocol may include things like:

6. Program Delivery

Intensive behavioural intervention services can be provided directly by the Regional Program, or purchased with funding, from private providers.

6.1 Receiving IBI Services From Regional Programs – Direct Service Option

If a family chooses to receive IBI services directly from the Regional Program, the Regional Program will:

  1. determine eligibility for intensive behavioural intervention services;
  2. determine the service intensity/setting/duration of IBI required;
  3. develop a Service Agreement with the family that identifies:
    • roles/responsibilities of the Regional Program;
    • the family's role/responsibilities;
  4. develop a specific program to meet the child's Individual Program Plan goals; and
  5. review the child's Individual Program Plan at regular intervals, minimally every six months and modify or adjust it based on the child's progress.

6.2 Purchasing Services Privately – Direct Funding Option

Direct Funding Option Overview

All Regional Programs must offer families the option of funding to purchase intensive behavioural intervention services privately. They will support families who choose this option and assist them in its implementation.

To receive funding, parents must provide information about the child's diagnosis and other personal contact information, including a copy of the child's formal assessment and diagnosis. The Regional Program determines eligibility and approves funding based on the clinically recommended level/intensity of service.

The Regional Program will provide the family with information about the funding available for private IBI services. Funding is consistent with the range of costs for Regional Program IBI services. It is based on the average salary costs of instructor-therapists and psychologists in the Regional Program. Rate calculation includes the average costs of services provided by the instructor-therapists who work directly with the child and supervision costs.

The hourly rate will be multiplied by the number of IBI hours of services approved by the Regional Program in the child's Individual Program Plan to reach a total amount of funding. On signing an IBI Services Funding Agreement families will receive a lump-sum payment for the first quarter of service delivery.

Available funding may not cover all of the costs incurred through a private arrangement. Parents must pay any additional out of their own resources.

Funding is to be used for approved intensive behavioural intervention services only, and may not be used to pay for any other services. For example, if the child is attending a centre that provides services such as physiotherapy and music therapy in addition to IBI, this funding can only be used for his/her IBI services.

Regional Programs will provide funding for services which they determine as being adequately clinically supervised. Funding levels will be reviewed at least every six months to ensure that funding is consistent with services being provided. In addition to providing funding to families to purchase services privately, the Regional Program will also offer these families other services including: parent/family training programs and transition supports.

Transition supports for families who purchase intensive behavioural intervention services through the direct funding option will be provided by the Regional Program. It is the family's responsibility to advise the Regional Program if they are in need of transition supports at least six months prior to the child's entry into school and/or community agency.

Roles and Responsibilities of Regional Programs for the Direct Funding Option

If the family chooses to receive funding to purchase IBI services from a private provider, the Regional Program will:

  1. determine eligibility for intensive behavioural intervention services;
  2. determine the service intensity/setting/duration of IBI required;
  3. give the family information about funding available, including the hourly rate for services and supervision;
  4. refer the family to Autism Ontario for information about known private agencies currently providing intensive behavioural services for children in the region;
    Note: The family is responsible for finding and contracting with a private provider, not the Regional Program.
  5. approve the service provider
  6. develop a Funding Agreement with the parents that at a minimum identifies the level of funding provided by the Regional Program; the approved level of IBI service; the supervisor for the instructor therapist providing the service; the level of supervision required/expected; and any other information required from the parents and/or IBI service provider that will aid the Regional Program in monitoring IBI services
  7. administer funding, according to the Funding Agreement, and reconcile any unspent funds;
  8. reassess the child's progress and continuing service needs, at least every six months, in collaboration with the Supervising Psychologist of the private program and the child's file; and
  9. provide transition supports if requested to do so by the family.

Roles and Responsibilities of Private Providers

The selected private provider will, in accordance with the program guidelines:

  1. develop a program to meet the goals of the child's Individual Program Plan;
  2. deliver IBI services;
  3. provide clinical supervision to staff providing the service by a psychologist registered or eligible for registration with the College of Psychologists of Ontario who also has training and extensive clinical experience in intensive behavioural intervention for children with autism. Note: In some circumstances the Regional Program may approve a professional with a Master's level degree in psychology or a related discipline plus several years of direct experience in supervising IBI programs and with access to a consulting registered psychologist to perform this role. In these cases the clinical accountability will remain with the approved clinical supervisor and not with the Regional Program;
  4. provide input into regular Individual Program Plan reviews; and
  5. develop a plan to discharge/transition the child from the program, providing appropriate linkages to the Regional Program.

6.3 Families Who Move While Receiving IBI

When a family that is receiving IBI, moves to an Ontario community outside the boundaries served by their Regional Program, there is no guarantee that the family will continue to receive services or that a vacancy for IBI services will be available in the new home region. This applies regardless of whether service was provided through the Regional Program or a private provider.

The sending agency must:

The receiving Regional Program must make accommodations to meet the family's needs as best it can, given current program demands, i.e. provide IBI services if available, or refer to other services/supports.

6.4 Staffing

Regional Programs will require a range of staff to address all of the components of the program, including management and administration, assessment, IBI delivery, child and family support services and transition supports.

In addition, Regional Programs are required to develop short- and long-term strategies for recruiting and training the clinical staff needed to deliver high quality intensive behavioural intervention. Training Supervisor positions exist within each Regional Program.

6.4.1 Core Clinical Staffing

It is expected that each Regional Program will have the following core clinical staff to deliver the intensive behavioural intervention:

A Clinical Director is responsible for overseeing, monitoring and evaluation of the intensive behavioural intervention, as well as overseeing assessments and Individual Program Plans. This will include providing training and supervision of senior therapists, interns and trainees to support the overall quality and consistency of the behavioural intervention approach. It will also involve responsibility for fulfillment of the provincial information and evaluation requirement. Regional Programs may need to employ additional clinical psychologists/psychologist associates to support the program.

Qualifications: The Clinical Director will have training and extensive clinical experience in intensive behavioural intervention for children with autism; have a doctoral degree in Psychology; and be registered or eligible for registration with the College of Psychologists of Ontario.

Senior Therapists are responsible for a set number of children and for supervising the instructor-therapists who are working with these children. Senior Therapists will also participate in intensive one-on-one and small group instruction. They will need to accept ongoing clinical supervision from the Clinical Director/Supervising Psychologist to support their intervention work. They will provide families with training related to behavioural intervention and home programming. Qualifications: Senior Therapists should have or be working towards a master's level graduate degree in psychology or related field, and six months to a year of direct clinical experience in an intensive behavioural intervention program for children with autism. Alternative combinations of extensive clinical experience in intensive behavioural intervention with children with autism and other educational backgrounds might also be appropriate for Senior Therapists. The number of Senior Therapists necessary will vary across regions depending on the number of children to be served.

Instructor Therapists are responsible for providing intensive one-on-one and small group instruction. To support this work, these therapists will be responsible for maintaining a daily data book for each child that will help in monitoring the child's progress. Senior Therapists supervise Instructor Therapists. Qualifications: Instructor therapists should be community college or university undergraduates in a related field. Previous experience providing intensive behavioural intervention would be of benefit. Alternative combinations of experience and educational background may also be appropriate for Instructor Therapists.

6.4.2 Other Resources

Regional Programs are expected to access existing community services to the greatest extent possible, for assessment, service coordination and administrative purposes. In addition, Regional Programs have been provided with the following:

Wait List Coordinators assist families waiting for assessment or for Intensive Behavioural Intervention services, coordinate and link families to formal and informal resources. In addition, the Wait List Coordinator delivers child and family support services. Qualifications: Wait List Coordinators should be community college or university undergraduates in a related field and have experience in delivering intensive behavioural intervention. Alternative combinations of experience and educational background may also be appropriate.

Transition Coordinators work with school boards and community agencies to set up protocols for the transition of children from the Autism Intervention Program. Coordinators will work with the child's family and Senior Therapist, and invite schools and community agencies to help develop a transition plan, based on the skills the child will need in school and the community. Transition Coordinators provide a one-point of contact for families and school personnel to implement and coordinate a smooth transition. They provide consultation on working with children with autism to schools or community agencies, upon request. They also provide the twelve months of ongoing transition supports for children discharged from IBI and making the transition to school. Qualifications: Transition Coordinators should have a community college diploma or university undergraduate degree in a related field. Direct clinical experience in an intensive behavioural intervention program for children with autism is recommended as is in-depth knowledge and experience in community-based services and awareness of special education policies and procedures. Alternative combinations of experience and other educational backgrounds may also be appropriate.

Training Supervisors deliver therapist training. Qualifications: The key requirements for these positions include:

Regional Programs may also, where appropriate, use paraprofessionals to support program delivery. Paraprofessionals incorporate into other settings the principles and approaches proven effective in the Autism Intervention Program.

6.5 Training/Education in Broader Service Delivery System

Regional Programs have the ongoing responsibility to provide staff training for Instructor and Senior Therapists according to provincially approved curriculum. Training and education of the broader service delivery system is essential to achieving the goals of this autism initiative including:

Each Regional Program must have designated Training Supervisors who meet the criteria established by the ministry for the position.

Other responsibilities of Regional Programs with respect to training include:

Through a negotiated agreement, the Regional Program will provide training to staff working with the child in these settings. Paraprofessionals may include, but are not limited to: parents, volunteers, child care workers, child and youth workers and/or educational assistants.

6.6 Accountability

Families

Families are to be provided every opportunity to be involved in program decisions that affect their children. In addition to providing informed consent at various stages of assessment, program planning, discharge and transition, families have opportunities for education and training to support their children.

The family is responsible for monitoring the quality of service delivered by private providers through the direct funding option. The family is also responsible for contacting the Regional Program at least six months prior to the child's transition to school and community agency if they require transition support services.

Regional Programs

Regional Programs are accountable to the families they serve for the quality of their services. They are required to develop procedures for:

In addition, Regional Programs are accountable to the Ministry of Children and Youth Services for the management of the program and service delivery, in accordance with government policies, service contract requirements and guidelines.

Ministry of Children and Youth Services

The local office of the Ministry of Children and Youth Services will negotiate a service contract that:

The regional office will monitor on a regular basis.

Evaluation

The Ministry of Children and Youth Services is committed to monitoring the Autism Intervention Program to determine that the program achieves its goals and objectives and makes efficient use of public resources. Systemic processes and outcome evaluation will be done periodically by the ministry and the results reported.

Revision of Program Guidelines

It is expected that, when required, the program guidelines for the Autism Intervention Program will be revised to incorporate policy clarifications and program adjustments.

Revision History: September 2000
September 2004
November 2004
August 2006

Independent Review Mechanism

PDF format

Guidelines

Independent Review Mechanism
(Appendix to Autism Intervention Program Guidelines)

December 14, 2012

Contents

SECTION I: ABOUT THE INDEPENDENT REVIEW MECHANISM

Purpose and Overview
Principles guiding service delivery
Goals

SECTION II: ADMINISTRATION OF THE INDEPENDENT REVIEW MECHANISM

IRM Coordinator
Roster of Independent Reviewers
Qualifications for Roster Membership
Education of Roster Members
Quality Assurance

SECTION III: PROCESS FOR REVIEWS

Overview
Steps and Timelines

SECTION IV: MONITORING AND EVALUATION

Program Outcomes


SECTION I: ABOUT THE INDEPENDENT REVIEW MECHANISM

Purpose and Overview

The purpose of the Independent Review Mechanism (IRM) is to enhance the consistency, transparency and fairness of decisions made regarding a child’s eligibility or discharge from the Autism Intervention Program (AIP). Please refer to the AIP Guidelines for more information about the AIP.

Through the IRM, parents/caregivers of children and youth with Autism Spectrum Disorders (ASD) may initiate reviews of decisions regarding eligibility for or discharge from the program. Psychologists and psychological associates who are independent from the AIP service delivery review AIP decisions and then determine whether the AIP provider’s decision is supported by the information in the case file materials.

Principles guiding service delivery

The following principles will guide the operation of the IRM:

SECTION II: ADMINISTRATION OF THE INDEPENDENT REVIEW MECHANISM

IRM Coordinator

The Ministry contracts with a Transfer Payment Agency to act as the IRM Coordinator and to administer the IRM process. This agency is not involved in autism service delivery and provides service in English and French.

The role of the IRM Coordinator is to coordinate the IRM across Ontario by:

The IRM Coordinator has an administrative role only in the independent review process; it does not have any decision-making authority regarding the decision of AIP providers or independent reviewers.

Roster of Independent Reviewers

The IRM Coordinator is responsible for recruiting and maintaining a roster of independent reviewers who will conduct reviews of AIP decisions. The Coordinator will assign one independent reviewer per case to conduct a review based on his or her clinical judgment and the relevant evidence in the case file materials.

The roster is composed of psychologists and psychological associates working in the field of ASD. These professionals may include private practitioners, public sector psychologists and psychological associates, or academics with clinical experience.

AIP providers, both Direct Service Option (DSO) and Direct Funding Option (DFO), and their staff are not eligible to be on the reviewer roster. Practitioners formerly employed by an AIP provider and former DFO private providers are eligible for membership on the roster, however they may not review decisions made by the AIP provider (DSO or DFO) with which they were associated, nor decisions regarding children they may have had as clients. The Coordinator will identify these and other potential conflicts of interest to ensure reviews are not conducted by reviewers who may have a conflict of interest related to the review.

Qualifications for Roster Membership

The minimum qualifications are:

Out of province clinicians are eligible for roster membership if they are registered in good standing to practice in their home jurisdiction.

Education of Roster Members

The IRM Coordinator will develop and deliver education to roster members on up-to-date research on IBI and the policies and procedures of the AIP.

Quality Assurance

The IRM Coordinator will promote quality in the IRM process by monitoring independent reviewers to ensure timelines are met, guidelines are followed and appropriate rationale is provided for decisions, as well as developing and monitoring inter-rater reliability (i.e., concordance in the degree of agreement among reviewers). It establishes a quality management system that includes providing feedback to providers.

SECTION III: PROCESS FOR REVIEWS

Overview

The IRM will review decisions related to eligibility for and discharge from the AIP following a multi-step process that includes an internal administrative review and, if necessary, a review by an independent psychologist or psychological associate. Service providers will communicate the option of and process for an independent review to parent(s)/caregiver(s) both when an eligibility decision is communicated, and again when a discharge decision is communicated.

Steps and Timelines

The independent review process will be completed within 75 business days from the date an AIP decision is communicated to the parent(s)/caregiver(s). The 75 business days include:

The following are the steps and timelines of the IRM process:

  1. AIP Decision

    The AIP provider will discuss its eligibility or discharge decision with the parent(s)/caregiver(s) and provide notice of this decision in writing. Parent(s)/caregiver(s) will be informed that they have 20 business days from the date they receive the written decision to request a review. Parent(s)/caregiver(s) will request a review in writing to the AIP provider. The provider will register the request with the IRM Coordinator who will open the file and notify the parent(s)/caregiver(s) that their request has been registered. Parent(s)/caregiver(s) may end the review process at any time.

  2. Internal Administrative Review

    If the parent(s)/caregiver(s) decides to request a review, the service provider will first complete an internal administrative review. This is a mandatory step in the IRM process.

    The purpose of the internal administrative review is to review the process by which the service provider made an eligibility or discharge decision, and to allow both the parent(s)/caregiver(s) and service provider an opportunity to reach a mutual understanding regarding the child’s or youth’s case file materials by reviewing, discussing, and modifying/accepting previously made decisions.

    In addition to the clinical data about their child on file with the AIP providers, parent(s)/caregiver(s) may provide any additional information and supporting documentation about their child’s care and treatment to the AIP provider that is relevant to the decision under review (e.g., information about their child’s diagnosis, their behaviours, or other treatments or assessments outside of IBI, etc.).

    The administrative review will be conducted by the individual who oversees the AIP program (i.e., the Executive Director or his/her designate) to whom the Clinical Director reports. In this stage, the administrative reviewer will:

    • Ensure the child’s case file materials contains all necessary information in support of the decision, subject to the College of Psychologists of Ontario’s Standards of Professional Conduct, the Personal Health Information Protection Act, 2004 and other applicable legislation;
    • Ensure that no administrative errors were made during the AIP decision making process;
    • If appropriate, request that the Clinical Director or his/her designate provide a more comprehensive summary report in support of the eligibility or discharge decision. The report will be communicated to and discussed with the parent(s)/caregiver(s);
    • Consider any additional documentation from the parent(s)/caregiver(s); and
    • Take appropriate action, if any.

    The internal administrative review will be completed within 15 business days of the date the parent(s)/caregiver(s) request the review.
    • Within the first 10 business days, the AIP provider must conduct its internal administrative review and discuss the outcome of the internal administrative review with the parent(s)/caregiver(s).
    • Within the remaining five business days, the parent(s)/caregiver(s) will decide whether they wish to proceed with the independent review and notify the AIP provider of this decision in writing. The AIP will then communicate the outcome of the internal administrative review to the IRM Coordinator, including whether or not parent(s)/caregiver(s) wish to proceed with the independent review.

  3. Referral to IRM Coordinator/Independent Reviewer

    If, after the internal administrative review is completed, the parent(s)/caregiver(s) wishes to proceed with the independent review, the AIP provider will forward the case file materials (with written parental consent) including the supporting documents from the parent(s)/caregiver(s), to the IRM Coordinator and provide a copy to the parent(s)/caregiver(s) subject to the College of Psychologists of Ontario’s Standards of Professional Conduct, the Personal Health Information Protection Act, 2004 and other applicable legislation.

    Upon receiving the case file materials from the AIP provider, the IRM Coordinator will confirm receipt to both the AIP provider and the parent(s)/caregiver(s), and forward the case file materials to an independent reviewer within five business days.

    The IRM Coordinator will ensure anonymity of the child and the parent(s)/caregiver(s) involved by removing any identifying information regarding the region, AIP providers, other service provider, parent(s)/caregiver(s) and the child, etc. from the case file materials.

    The IRM Coordinator will inform the AIP provider and the parent(s)/caregiver(s) of the status in the process and next steps.

  4. Review by the Independent Reviewer

    The independent reviewer will determine if the AIP decision is consistent with the information in the case file materials based on his/her clinical judgment and the AIP Guidelines.

    Types of ReviewsDecision ConsistentDecision Inconsistent
    1. Eligibility (not eligible for IBI)Child or Youth not eligible for IBIChild or Youth is eligible for IBI and is placed on a waitlist based on date of original referral to AIP
    2. DischargeChild or Youth should be dischargedChild or Youth should not be discharged at this time and will remain in the AIP

    While a discharge decision is under review, the child will continue with the transition process, which may include a reduction in service intensity (i.e., the number of hours of IBI a child receives per week), but will not be discharged from IBI.

    The reviewer will provide his or her decision and rationale in writing to the IRM Coordinator within 30 business days of receiving the case file materials.

  5. Notification

    The IRM Coordinator will notify the AIP provider and parent(s)/caregiver(s) within five business days from the day the Coordinator receives the decision from the reviewer. The reviewer will provide his or her decision, its rationale and outcome in a standardized written form to the IRM Coordinator, which will provide it to the parent(s)/caregiver(s) and AIP provider involved.

  6. Resolution
    1. Eligibility Decisions
      If a decision of eligibility is made, the child will be placed on the waitlist by date of original referral to the AIP. Where the original ineligibility decision stands, AIP providers will continue to refer parent(s)/caregiver(s) to other community resources, as per standard AIP procedures.
    2. Discharge Decisions>br /> If the AIP provider’s decision to discharge a child stands, then the original provider decision remains in effect and the child will continue with the transition process out of the AIP (e.g., through the Connections for Students model for children who are starting or continuing in a publicly-funded school). These children will also be able to apply for other MCYS-funded community-based supports, such as Applied Behaviour Analysis-based Services and Supports, respite, and March Break and Summer Camps.

    If the decision is that the child or youth should not be discharged, the agency responsible will take appropriate action to comply with the independent reviewer’s decision. The child will return to his or her existing service stream (i.e., the Direct Service Option or the Direct Funding Option) to continue IBI.

    A decision made by the independent reviewer is final and the IRM cannot review it again. However, if a child returns to service following a discharge decision, future discharge decisions are eligible for review. The most recent IRM decision is final and supersedes any previous discharge decisions.

Service Pathway for the IRM

# of DaysSteps
201. After being notified of decision by AIP provider, family initiates review process in writing
152.Internal Administrative Review including family decision on whether or not to proceed to independent reviewEither: Issue resolved or move on to step 3.
53. Issue not resolved - IRM Coordinator receives file, selects independant reviewer
304. Independant reviewer determines if AIP decision is:
  1. Consistant with information in the case file materials; or
  2. Inconsistant with information in the case file materials.
Results sent to IRM Coordinator
55. IRM Coordinator notifies AIP provider and family of the result of the review in writing
75 Days Total

SECTION IV: MONITORING AND EVALUATION

The IRM Coordinator has a service contract with MCYS. The service contract includes requirements for the collection of information consistent with the Ministry’s approach to performance measurement to support decision-making and business planning.

The IRM Coordinator will collect and report information pertaining to IRM service delivery and system outcomes, for example, information related to the:

The IRM Coordinator will develop a summary of IRM outcomes and performance as described above and submit to the ministry on a quarterly basis.