Amy Timo, BAS Clinical Consultant Empirically Supported Best Practices PA Bureau of Autism Services April 25, 2013 Amy Timo, BAS Clinical Consultant

April is Autism Awareness Month “Every April during National Autism Awareness Month, we recognize the special challenges faced by those living with Autism Spectrum Disorders (ASD) and refocus our efforts on the best ways to support them and their families.” -HHS Secretary, Kathleen Sebelius

Today’s training will cover… Defining Best Practices Bureau of Autism Services Best Practices Empirically Supportive Interventions from the National Standards Project and other resources

Disclaimer We must keep in mind that a particular practice that has worked for someone within a given set of variables may or may not yield the same results across other variables.

Best Practice What is a best practice? A best practice is a method or technique that has consistently shown results superior to those achieved with other means, and that is used as a benchmark. In addition, a "best" practice can evolve to become better as improvements are discovered.

Best Practices continued… Best practice is considered by some as a “buzzword”. Best Practices are found in … Commercial Businesses Education Psychology Many more fields

Empirically Supported Treatments (EST) Prior to the 1990s, there were no specific guidelines for either practitioners or consumers regarding which treatments to select for which conditions. As a consequence, the field was plagued by serious problems with quality control.

Empirically Supported Treatments are… Interventions that have been found to be effective for one or more condition. Treatments that have medical evidence or research to show they work. Based upon randomized control trials using a control group and an experimental group They of course have pros and cons, as not ever empirically supported treatment will work for all cultures, and situations, etc.

Evidence Based Practices (EBP) Entails making decisions about how to provide care by integrating the best available evidence with practitioner expertise and other resources. The with the characteristics, state, needs, values and preferences of those who will be affected is taken into consideration. Unfortunately, the term "evidence-based practice" is not always used in such a rigorous fashion.

ESTs/EBTs cannot stand alone. EST and EBP Disclaimer ESTs/EBPs are strongly emphasized but they need to be placed in context and viewed within the larger perspective. ESTs/EBTs cannot stand alone.

Innovative Research Research deemed innovative may May be unproven. introduce a new paradigm, challenge current paradigms, look at existing problems from new perspectives, or exhibit other uniquely creative qualities. May be unproven.

Bureau of Autism Services’ Philosophy “The Bureau of Autism Services believes that supports and instruction in all services provided in the Adult Autism Waiver should focus on effectively teaching meaningful and functional skills in inclusive settings while promoting self- determination and independence.”

BAS defines Best Instructional Practices… “Best Instructional Practices are techniques, methods and strategies that are proven through research to be more effective than other techniques, methods and strategies.”

What are the BAS Best Practices? The Best Instructional Practices that support this philosophy include: Individualized Assessments Systematic Planning Instruction through efforts that are data driven and collaborative

Individualized Assessments Quality of Life Questionnaire (QOL) and the Scales of Independent Behavior Revised (SIB-R). Are used to determine a participant’s current level of daily functioning Will give a “snap shot” of the participant’s abilities in relation to particular skills

Individualized Assessments continued… Are tools for informing present level of performance. Required to be conducted with each participant at intake and annually in the Adult Autism Waiver. Are integral in helping to understand the participant’s present level of performance, or baseline.

Systematic Planning Identifying a participant’s needs should ultimately be determined through a person centered, ecological process.

Instruction Goals and Objectives need to be measureable and observable. Goals are long-term, global statements that are typically written with an annual measure. Objectives reflect short-term benchmark or steps to meet the goal.

More on Objectives Good instructional practice warrants a specific, planned method by which to present a new skill and encourage practice and acquisition of skill. Prompting and Fading Reinforcement and Error Correction Task Analysis Generalization and Maintenance

Functional Behavioral Assessment What is a FBA? A Functional Behavioral Assessment (FBA) is a systematic approach to understand WHY a person engages in challenging behaviors. Can address negative behaviors (e.g. social issues, withdrawal) or more severe overt behaviors (e.g. physical aggression).

Steps to Complete FBA Step 1: Prioritize and Define Behavior Step 2: Indirect Data Collection Step 3: Direct Observation Step 4: Analysis of Information Next Step: Develop Behavior Support Plan/Crisis Intervention Plan

Best Practices outside of BAS National Autism Center Center for Disease Control National Institute of Health Disclaimer- most National Projects are geared towards individuals 21 years old and younger

National Standards Project A primary initiative of National Autism Center Addresses evidence-based practice guidelines for ASD Identify the level of research support currently available for educational and behavioral interventions used with individuals with ASD (below 22 years of age). Help caregivers, parents, educators and service providers use critical information in making treatments decisions. Identify limitations of current body of research Offer recommendations for using evidence-based practice for ASD

Disclaimer “The National Standards Report is not the final word on treatment effectiveness in autism — indeed, it is intended to start rather than finish an important conversation — but it may be the best available word. It provides a snapshot of what the available research currently tells us and of what additional research is needed."

11 Established Treatments Antecedent Package Behavioral Package Modeling Schedules Self-Management Naturalistic Teaching Story-based Intervention Package Comprehensive Behavioral Treatments for Young Children Joint Attention Intervention Peer Training Pivotal Response Treatments

Bureau of Autism Services Thursday Targeted Training February 23, 2012 National Standard Project Report Addressing the Need for Evidence-Based Practice Guidelines for ASD Patty Gould-Lucht, BAS Clinician Stacy L. Nonnemacher, Ph.D.| Senior Clinical Consultant

Center for Disease Control Behavior and Communication Approaches Applied Behavioral Analysis Discrete Trial Training (DTT) Early Intensive Behavioral Intervention (EIBI) Pivotal Response Training (PRT) Verbal Behavior Intervention (VBI)

National Institute of Health ABA Cognitive Behavioral Therapy Social Skills Training

As always… Treatment interventions need to be: Individualized Linked to “needs” e.g. Based on function of behavior (learned through FBA) Align with program or service expectations Suitable to be effectively carried out in setting e.g., home, work etc. Understood by all - train staff and family for consistency Documented - treatment data collected and reviewed 3rd bullet- for example an intervention that may be appropriate for a Behavior Specialist to implement, may not be appropriate for a job provider.

References National Standards Report – The National Standards Project - Addressing the Need for Evidence-Based Practice Guidelines For Autism Spectrum Disorders, National Autism Center. Findings and Conclusions; National Standards Project National Autism Center website – NSP Report: http://www.nationalautismcenter.org/nsp/reports.php Manente, Christopher J.; Maraventano, James C.; LaRue, Robert H.; Delmolino, Lara; Sloan, Donna. Effective Behavioral Interventions for Adults on the Autism Spectrum: Best Practices in Functional Assessment and Treatment Development. Behavior Analyst Today, Jan. 2010, Vol. 11 Issue 1, 36-48. Center for Disease Control- http://www.cdc.gov/ National Institute of Health- http://www.nih.gov/