1. 12th Biennial National Conference Choices that matter: ECI in a new era … 7-9 September, 2016 Melbourne, Australia The Efficacy and Feasibility of the Irabina Early Intensive Model: A Group-Based Intervention for Children with ASD Presented by Dr Jose Molina, Clinical Services Manager Irabina Autism Services josem@irabina.com

2. Who is Irabina? Not-for-profit organisation Young people and families adapt to the challenges with Autism Spectrum Disorder (ASD). We have delivered expert support & education services for 50 years Programs & services for individuals aged between 0 - 21 years. Family-centred approach ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

3. What Services do we offer? Speech Therapy Occupational Therapy Psychology Aquatic Programs Social Skills Programs Sport & Activity bases programs Parent support School Holiday Programs Auskick Diagnostic Clinic ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

4. Existing group programs Group intervention for children between 3 and 5 years old Weekly two-hour sessions Groups based on age and developmental goals However Many parents expressed the need for an intensive, early intervention group (ESDM) ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

5. Evidence for ESDM group interventions Gains in visual reception, receptive language, and expressive language (15 to 20 hours per week; 1:4 ratio; no specific parent training) (Eapen et al., 2013). Gains in cognitive and social skills, and adaptive abilities (15 to 25 hours per week; 1:3 ratio; limited parent training) (Vivanti et al., 2014). ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

6. What we knew Gains in cognitive, adaptive and social and language skills ESDM-based groups show a greater developmental rate But Implementation is costly (funding is required) ESDM is a “resource intensive model to implement”. Centre “experiences considerable pressure” (Vivanti et al., 2014) ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

7. Irabina Intensive Group 18 children 24 to 48 months old Early Behavioural Intervention:12 to 20 hours per week Early Start Denver Model (play-based interventions, following a developmental and relationship-based approach, child-lead activities) Applied Behaviour Analysis (Behavioural teaching techniques, functional behaviour analysis, measure of behaviours/progress) TEACCH (Visual supports, physical organisation, scheduling, use of behavioural teaching methods) DIR Floortime (Individual and developmentally appropriate teaching plans, string emphasis in relationship, child-lead activities) Staff : Child ratio of approximately 1:3 ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …

8. Irabina Intensive Group ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Enrollment is term-based Cost:$6,300 per term (12 hours a week) $8,800 per term (20 hours a week) Funding options: HCWA and Fee for Service

9. The Clinical Team ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Behaviour Therapist Specialist Teacher SP OT Psych Educational Assistant

10. Program goals/Activities ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Individualised assessment/treatment plan Individual goals based on the ESDM curriculum Clinicians plan learning activities based on the group’s term goals –Joint activity routines to entice learning –Child lead –Highly motivating materials

11. Example ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Activity centre: Play dough (3 children – 1 therapist): –Imitation of actions on objects –Name or pointing objects –Giving/taking objects using eye contact –Identifying shapes –Sharing with peers –Request using words/gestures –Turn taking/Waiting

12. Example ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Music time: “Rosie the elephant” (7 children – 1 therapist, 1 support, 1 “floater”): –Matching identical pictures –Imitating animal sounds –Giving/taking objects using eye contact –Imitating visible motor actions in song –Imitating actions on objects (pasting) –Labelling body parts –Turn taking/Waiting

13. Parent involvement ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Initial parent interview (goal setting) Three-monthly meetings to discuss progress and goals Parents provided with a client folder including goal sheets: –Goal title –Target behavior –Prerequisite skills –Materials –Suggested teaching procedure –Prompting techniques –Teaching tips and strategies

14. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 9:00 – 9:30 am Arrival of group members Outdoor Play Separation Independent play Parallel play Play sequences/themes 9:30 – 10:00 Music/movement Object activation Songs Social sensory routines Gestural and vocal imitation Joint attention Turn taking Making choices Receptive language

15. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 10:00 – 10:30 am Activity centres Home corner / Duplos / Play dough Matching / Interactive stories / Themed play Fine motor abilities Cognitive abilities Communicative and social skills 10:30 – 10:45 Snack Following familiar routines Self care Personal independence Conversational skills

16. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 10:45 – 11:00 Story time Story books Receptive/Expressive language Gestural and vocal imitation Turn taking/Joint attention Cognitive abilities 11:00 – 11:15 Outside play Gross motor abilities Social play Parallel play Independent play

17. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 11:15 – 11:45 Gym Ball play Crawling/Climbing/Jumping/Balancing Tunnel /Slides/Stairs/Swings Gross motor abilities Social play 11:45 – 12:10 Playground/Trike circuit Sand pit/ Trampoline Cubby house Gross motor abilities Social play Independent play

18. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 12:10 – 12:25 Music and movement Songs Social sensory routines Expressive and receptive language Gestural and vocal imitation Turn taking Joint attention 12:25 – 12:40 Group sensory play Stickers/Pasting Finger paint/Play dough Sensory toys Fine motor abilities Social sensory routines

19. Intensive group session structure ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … ActivitiesGoals 12:40 – 1:00 Lunch time Following familiar routines Self care Personal independence Conversational skills 1:00 – 1:30 Free play Sibling interaction Feedback to parents Farewells Independent play Social skills Following familiar routines

20. Intensive group session structure Activities 2:00 – 3:00 Clinical and planning meeting Individual goals review Activity review Data processing

21. Outcome measures ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Mullen Scales of Early Learning Planned: –Autism Diagnostic Observation Schedule –Vineland Adaptive Behaviours Scale –Child Behaviour Checklist –MacArthur-Bates Communicative Development Inventories

22. Developmental outcomes (MSEL) ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … * p <.05

23. Challenges ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Tracking individual progress on a daily basis Adapting the existing rooms and resources (physical environment) Highly demanding for staff (teachers and allied health) Despite lower costs, it remains an expensive intervention model

24. The Strengths ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Intensive intervention Flexible model Responsive to individual needs Lower cost than similar models Generalisation of skills (parent feedback)

25. Future directions ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … Predictors of outcome NDIS? Intensive 1:1 vs Intensive group Intensive group with 1:1 component –Parent involvement (experiential) Measure VEYLDF outcomes –Identity –Community –Well-being –Learning –Communication

26. Parent feedback ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … “I have seen wonderful gains in my son’s development, behaviour and relationships than I thought possible in such a short amount of time”. “it is very rewarding to see your child thrive in a positive and caring learning environment” “my son thoroughly enjoys the play-based routines, and the group setting has markedly improved his social interaction with peers and adults alike”

27. Parent feedback ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … “Made a world of difference to our child's behaviour, speech and general social interactions with other children and adults”. “It’s a true partnership between staff and parents” “ongoing opportunities for discussion and review of each child's progress and overall therapy goals” “Provides right balance of fun, engaging social activities as a group versus opportunities to develop independent play”.

28. Parent feedback ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era … “The ESDM program is a large investment financially for parents. However the value of a program that incorporates psychology, speech and occupational therapy in one setting with multiple therapists cannot be appreciated until you see the program in action”

29. Questions? ECIA 12th Biennial National Conference, Choices that matter: ECI in a new era …