1. Learn with AFIRM: Autism Focused Intervention Resources and Modules
2016 Improving Data, Improving Outcomes Conference
New Orleans, LA
August 2016
Ann Cox, Ph.D.
Ann SAM, PH.D.

2. Objectives
Identify the source and process for the identification of 27 ASD evidence based practices
Know where and how to access AFIRM internet modules for learning more about EBPs
Identify how the AFIRM website can be used to support learning for B-K focused practitioners
Register and use the AFIRM website (if not already registered) and other EBP learning sites

3. Who We Are

4. What Interventions Work for Children with ASD?

5. What Are Evidence-based Practices?
Focused interventions that:
Produce specific behavioral and developmental outcomes for a child
Have been demonstrated as effective in applied research literature
Can be successfully implemented in educational settings
Are used for a limited amount of time
(Odom, Colett-Klingenberg, Rogers, & Hatton, 2010)

6. Previous Research Reviews: NPDC & NAC

7. 2014: Update on EBPs for Learners with ASD and Families
2014 update of EBP Review es/autismpdc.fpg.unc.edu/files/i mce/documents/2014-EBP- Report.pdf
Covered years
27 EBPs identified

8. NPDC Article Review Process
NPDC EBP Workgroup
NPDC EBP Workgroup
NPDC EBP Reviewers
NPDC EBP Workgroup
Title Review 29,105
Abstract Review ,449
Article Review 1,030
Final Check 546
The first round of screening focused on titles. Articles excluded at this stage were primarily those that clearly stated in the title to be commentaries, letters to the editor, reviews, and biological or medical studies. The second round of screening included an examination of abstracts to determine if the article included participants with ASD under 22 years of age and used an experimental group design, quasi-experimental group design, or SCD. In both rounds of screening, articles were retained if the necessary information was not clearly presented in the titles and abstracts (i.e., if the reviewer could not tell from the title or abstract if the article are appropriate).
456
acceptable studies

9. EBP Criteria Criteria for Qualification as an Evidence-Based Practice
At least two high quality experimental group or quasi experimental design articles OR
At least five high quality single case design articles
A combination of at least one high quality group experimental or quasi-experimental design article and at least three high quality single case design articles
When all articles were assembled into categories, a final determination was then made about whether a practice meets the level of evidence necessary to be classified as an EBP using criteria for evidence established by the NPDC. The NPDC’s criteria were drawn from the work of Nathan and Gorman (2007), Rogers and Vismara (2008), Horner and colleagues (2002 ), and Gersten and colleagues (2005), as well as the earlier work by the APA Division 12 (Chambless & Hollon, 1998).  
*refer to handout (bottom of third page)
These criteria are aligned with criteria proposed by other agencies and organizations

10. Age of Participants in Studies

11. Instructional Domains
Social
Communication
Behavior
Joint attention
Play
Cognitive
School readiness
Academic
Motor
Adaptive
Vocational
Mental health

13. Evidence – Based Practices (2014)
Antecedent-based interventions Cognitive behavioral intervention Differential reinforcement Discrete trial training Exercise Extinction Functional behavior assessment Functional communication training Modeling Naturalistic interventions Parent implemented interventions Peer mediated interventions Picture exchange communication Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Scripting
Self-management
Social narrative
Social skills training
Structured play groups
Task analysis
Technology aided instruction/intervention
Time delay
Video modeling
Visual supports

14. Foundational Evidence – Based Practices (2014)
Antecedent-based interventions Cognitive behavioral intervention Differential reinforcement Discrete trial training Exercise Extinction Functional behavior assessment Functional communication training Modeling Naturalistic interventions Parent implemented interventions Peer mediated interventions Picture exchange communication Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Scripting
Self-management
Social narrative
Social skills training
Structured play groups
Task analysis
Technology aided instruction/intervention
Time delay
Video modeling
Visual supports

15. Matrix of EBPs by Outcome and Age

16. What about Young Children with ASD?

17. Age of Participants in Studies

18. Outcomes
Although studies in the literature incorporated a wide range of outcomes, research focused primarily on outcomes that are considered the core symptoms of autism: social, communication, and challenging behaviors. Researchers focused on challenging behaviors most frequently (probably due to the young age). Play and joint attention were also reported in a substantial number of studies. However, school readiness and pre-academic/academic outcomes also appeared in a substantial number of studies.

19. Matrix of EBPs by Outcome and Age
Social
Communication
Joint Attention
Behavior
School-Readiness
Play
Cognitive
Motor
Adaptive
Academic EI
ECSE
ABI
CBI
DRA/I/O
DTT
ECE
EXT
FBA
FCT MD NI
PII
PMII
PECS
PRT PP R+
RIR SC SM SN
SST
SPG TA
TAII TD VM VS

20. Evidence – Based Practices (2014)
Antecedent-based interventions Cognitive behavioral intervention Differential reinforcement Discrete trial training Exercise Extinction Functional behavior assessment Functional communication training Modeling Naturalistic interventions Parent implemented interventions Peer mediated interventions Picture exchange communication Pivotal response training
Prompting
Reinforcement
Response interruption/redirection
Scripting
Self-management
Social narrative
Social skills training
Structured play groups
Task analysis
Technology aided instruction/intervention
Time delay
Video modeling
Visual supports

21. Implications of Findings
More research is needed to address focused intervention practices for infants and toddlers
Practitioners can build “eclectic”/evidence supported programs to address specific needs of children with ASD
Better child outcomes dependent on translation/use with fidelity of EBPs
Professional development in using EBPs is needed
Practitioners: using the EBP x age x outcome matrix, can create their own programs using different EBP to make a comprehensive program that is evidence-supported (vs CTM like Lovaas model & ESDM)
Researchers: reveals gaps in research, clear need is for more EI focused intervention research- CTMs for toddlers with ASD is expanding but really need to do focused for practitioners/families to build own technical eclectic programs; they have to extrapolate from the preschool (or older) studies which may not be developmentally appropriate (similar to concept in psychopharmacology- can’t just give same medications to younger children)
Finally- research to practice; emerging field of implementation science
Refer to NPDC- OCALI, coaching model

22. So Where Can You Turn?
LEARN with AFIRM

23. What is AFIRM?
Web-based, user-friendly resource for learning how to use evidence-based practices
Free but must register
Downloadable resource documents
Designed to award certificate of completion
Supports use in short amounts of time – can return to where left off to continue
Full of examples of steps of implementation
Supported with video examples
Interactive features

24. AFIRM: Let’s Take a Look

25. AFIRM http://afirm.fpg.unc.edu/ E-learning modules for 27 EBPs
Target audience
Special educators
General education teachers
Related service personnel
Early interventionism
Planning, using, monitoring EBPs

26. AFIRM Structure 4 lessons Key components of EBPs
Basics of EBP
Plan for EBP
Use EBP
Monitor EBP
Key components of EBPs
Step-by-step process for applying practice

27. AFIRM Features Engaging case examples
Multimedia presentation of content
Interactive assessments
Free professional certificate

28. AFIRM Supplemental Materials
Step-by-step practice guide
Implementation checklist
Parent’s guide
Tip sheet for professionals
Data sheets
Evidence-base for the practice

29. Implementing EBPs with Fidelity
Step-by-step guides
Implementation checklists

30. Monitor Progress

31. Summary Sheets for Professionals and Parents
Tip sheet for professionals
Parent’s guide

32. AFIRM Certificates

33. Self Team Family How to Use… Some Ideas Plan implementation
Check on my own knowledge
Use to observe video of my implementation
Professional development hours
Self
Use to observe video of a team member’s implementation
Use to practice step-by-step with team
Use to identify weak spots and strengths
Use to guide professional development resources
Team
Use to plan implementation with family
Have parent use as they observe me model implementation
Use to give family feedback on their implementation of a practice
Family

34. Who are Using the AFIRM Modules?
Occupation
Total
Administrator
699
Family Member
269
Early Interventionist
615
General Ed
518
Special Ed
2998
Health Care Provider
355
Related Service Provider
1112
Paraeducator/Instructional
849
Technical Assistant
293
University Student
1409
University Faculty
441
Other
1312
10870
June 2015-July 2016:

35. Early Interventionists and Early Childhood Users?
Occupation
0-2 years
3-5 years
Total
Administrator 17
131
148
Family Member 12 63 75
Early Interventionist
227
260
487
General Ed 23
105
128
Special Ed 33
451
484
Health Care Provider 21 78 99
Related Service Provider 30
217
247
Paraeducator/Instructional 10
149
159
Technical Assistant 3 71 74
University Student
140
173
University Faculty 16 64 80
Other 44
210
254
469
1939
2408
Total # of Unique 0-5 (B-K) AFIRM Users = 2408

36. How are They Using the AFIRM Site?
1529 certificates have been awarded to 600 B-K users
1717 evaluation surveys were completed by 706 B-K users
Top resources downloaded were:
CEC standards,
EBP Matrix,
EBP Brief packets,
Data Collection Sheets,
Evidence-base for practices,
Decision trees and diagrams,
Implementation checklists,
Step-by-step guides,
Working definitions of EBPs, and
Professional tips sheets

37. What are B-K Users Saying About AFIRM?
Now I have more tools to use in my classroom
I am blown away! Have shared with all our classroom teachers and behavior specialists
The handouts, check-ins, activities, data sheets, videos, and content are excellent
AFIRM
Videos provide great examples of implementation
Awesome

38. How do B-K Users Evaluate AFIRM Modules?
Surveys of Birth-5 Users: Scale of 1 to 4
Module
Surveys
Quality
Relevancy
Useful
Objectives
Antecedent-based Intervention 99
3.48
3.61
3.57
3.47
Discrete Trial Training 38
3.63
3.66
Exercise
189
3.49
3.26
Functional Behavior Assessment
171
3.55
3.56
3.5
Modeling 98
3.59
Peer-mediated Instruction & Intervention
136
3.42
3.38
3.31
3.43
Picture Exchange Communication System
3.64
3.62
Prompting
156
3.51
Reinforcement
197
3.6
Social Narratives
112
3.53
3.45
Social Skills Training 87
3.68
3.54
Task Analysis 81
Time Delay 62
3.52
Visual Supports
192
1717
Total # of Unique 0-5 (B-K) Users of Surveys = 706

39. What are Users Doing with the Information Gained?
Pre-survey information: 189 users
Specific ways in which information in
AFIRM modules have been applied to
your work?
Fall survey to 6000 users (or more)
2016

40. Other ASD EBP Learning Resources

42. EBP EI Resources ASD Toddler Initiative
Step-by-step directions for planning, implementing, and monitoring
Practice Case-based Scenarios
Implementation Checklists
Parent and Practitioner Guide
EBP Fact Sheet

43. http://asdtoddler.fpg.unc.edu Modules on the following practices:
Prompting
Naturalistic Interventions
Parent Implemented Intervention (under development)
Pivotal Response Teaching
Functional Behavioral Assessment
Reinforcement
Video Modeling

44. EBP Briefs http://autismpdc.fpg.unc.edu/ NPDC Website Overview
Evidence base
Steps for implementing
Implementation checklist
Sample data collection forms (optional)

45. Resources AFIRM modules: http://afirm.fpg.unc.edu/ NPDC on ASD:
ASD Toddler Initiative:

46. Questions?