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

2. 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

3. 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

4. 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.

5. 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.

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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.”

13. 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.”

14. 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

15. 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

16. 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.

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

18. 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.

19. 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

20. 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).

21. 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

22. 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

23. 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

24. 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."

25. 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

26. 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

27. 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)

28. National Institute of Health
ABA
Cognitive Behavioral Therapy
Social Skills Training

29. 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.

30. 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:
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,
Center for Disease Control-
National Institute of Health-