Toronto, August 10, 2016 – At Surrey Place Centre, we are committed to improving the lives of people living with Developmental Disabilities and Autism Spectrum Disorders by providing specialized clinical services that are responsive to individual needs and promote health and well-being. In order to achieve these principles, we value opportunities that allow us to work with our clients, families, and partners.
On Monday July 11, 2016, Terri Hewitt, Vice President of Community Programs and Margaret Howard, Director of Toronto Partnership for Autism Services (TPAS) and Toronto Autism ABA Services, met with several individuals and families and members from an advocacy group at 2 Surrey Place in Toronto. Those who attended the meeting raised questions around: eligibility criteria for Intensive Behavioural Intervention (IBI), waitlist management, clinician qualifications and quality assurance, the Independent Review Mechanism, Enhanced ABA Service, private providers, discharge criteria, and transition.
We appreciate the advocacy work of parents and families dedicated to ensuring children with Autism are provided with timely access to services and supports and would like to thank all those who attended the July 11th meeting. Agencies attempt to be consistent across Ontario whenever possible, and our responses are likely reflective across the province in many cases. For specific Regional practices, you may wish to contact the Regional Program directly. As the lead agency for TPAS and co-lead for Toronto Autism ABA Services, we are able to address the following questions below.
Referrals and Eligibility for IBI
The Autism Intervention Program Guidelines indicate that children must live within the geographic boundaries of the program and have a diagnosis from a physician or psychologist that states the child has Autism or an Autism Spectrum Disorder (ASD) toward the severe end of the Autism Spectrum Disorder. Children should be diagnosed by a physician or psychologist prior to contacting the Regional Program. The Guidelines explain that 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. 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. If additional information is needed, Clinical Directors or Supervising Psychologists will use the same core tools. These include diagnostic tools (DSM, CARS, ADOS), standardized cognitive tools, adaptive behaviour interviews, and language measures.
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. The Guidelines indicate that 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.
Waitlist Management
The Autism Intervention Program Guidelines expect that 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. Geography is a factor to be used to recognize the service communities within a region. In Toronto, families are presented with the Direct Funding Option (DFO) and the Direct Service Option (DSO) during the initial eligibility screening appointment, so they can begin considering their preference prior to receiving the eligibility determination.
When a child is deemed eligible, the family is asked their service preference, and is invited to contact Surrey Place Centre at any time if their preference changes. Following eligibility determination, families are invited to begin participating in the TPAS Parent Education Pathway which commences with an orientation to TPAS. During this session, families receive information about the strengths and requirements of each service option. Families that are interested in Direct Funding are invited to a more detailed orientation that provides information on selecting your team, quality indicators, and administrative requirements. Service preferences are also updated during regular contacts with Regional Program Family Support Coaches.
Clinician Qualifications and Quality Assurance
The breadth and depth of the combined clinical competence, experience, and operational expertise of our TPAS and ABA partners is significant. At Surrey Place Centre alone, we employ specialized Autism professionals with various levels of academic training. This can include graduate level academic training at the Masters and Doctorate level, faculty appointments in graduate psychology at York University, and medicine at the University of Toronto. Further, staff members have been appointed to serve on provincial Expert Panels on Autism.
Surrey Place Centre, along with Holland Bloorview Kids Rehabilitation Hospital and Hospital for Sick Children, were recognized and awarded the first Canadian site for the Autism Treatment Network. Together, we developed standards of clinical care for children with Autism based on research evidence and shared clinical practice in the medical community through trainee mentorship and medical education. Several years ago, we developed a Doctoral Level Psychology Internship program that provides Intensive Behavioural Intervention rotations. Currently the Psychology Internship is going through the final stages of Accreditation with the Canadian Psychological Association.
High quality, Intensive Behavioural Intervention for young children with an ASD is informed by ethical and professional guidelines including those of the Ontario Association on Behaviour Analysis (ONTABA), Ethical Standards of the Behavior Analyst Certification Board (BACB), the Canadian Psychological Association (CPA) Code of Ethics, and the College of Psychologists of Ontario’s (CPO) Standards of Practice. The Toronto Partnership for Autism Services (TPAS) and the Toronto Autism ABA Services are proud to support the continued development of behaviourally based services in Ontario. Staff members from Surrey Place Centre were key members in the original formation of ONTABA, an affiliated chapter of ABA International since 1991. Surrey Place Centre and Partner Agency staff have held significant positions within ONTABA, including several Presidents, Committee Chairs, and other Board positions.
Each year, TPAS and Toronto Autism ABA Services support practicum placements for hundreds of students completing ABA post-secondary programs through George Brown College, Seneca College, St. Lawrence College, Humber College, as well as Masters Programs at Brock and Western. Additionally, our staff members were involved in the development and formation of these programs through: memberships on professional advisory committees, course development, curriculum reviewers, and teaching positions. We were among the earliest adopters of Behavior Analyst Certification Board requirements in Ontario, including providing supervision for Board Certification, and including Board Certification as an employment requirement. As a result, we were significant contributors to the tremendous growth of Board Certification across the province. We continue to employ a significant portion of the Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts in the province. With more than 30 currently employed within our agencies and with dozens of staff completing course work for certification or collecting hours required for certification, we believe we are contributing significantly to the future health and sustainability of the system supporting children with an ASD.
Core Clinical Staff are identified within Ministry Guidelines and we adhere to these standards within both Direct Service and Direct Funding options. Within the Direct Service model, our staff are highly qualified and we ensure organization, administrative, programming, and teaching supports are in place to enable quality assurance and continuous improvement of service delivery. Quality assurance and accountability mechanisms are extensive and include (but are not limited to): SPC Board of Directors Quality Assurance Committee, agency Accreditation, implementation of the York System of Quality Assurance for Intensive Behavioural Intervention Programs for Children with Autism, regular reviews of key performance indicators, standardized training and evaluation systems, provincial and agency research, evaluation, and outcome measurement tools.
Independent Review Mechanism in the New Ontario Autism Program
We understand that an advisory committee of parents, advocates, service providers and experts will continue to provide advice to the government on the design and implementation of the Ontario Autism Program
Enhanced ABA Service
Service providers and families have been working collaboratively for many years to build and enhance a comprehensive system of supports for children and youth with an ASD and their families.
The Ministry of Children and Youth Services announcement regarding the new Ontario Autism Program (OAP), which will begin in June 2017, will deliver more individualized autism treatment with a range of intensity and flexibility of service to meet the individual needs of each child. Children will receive expanded Applied Behaviour Analysis (ABA), and the total amount of ABA available per child will increase. Children will be assessed upon entry to the program and will receive supports at the level of intensity, based on their individual needs and the most current scientific evidence. We look forward to working with the Ministry, advisory committee, and families to build a strong and responsive service system that will assist children and youth to reach their fullest potential and lead healthy, socially inclusive lives.
Private Providers
The Autism Intervention Program Guidelines indicate the Regional Provider will refer the family to Autism Ontario for information about known private agencies currently providing intensive behavioural services for children in the region. The Guidelines note that the family is responsible for finding and contracting with a private provider, not the Regional Program. The Regional Program is responsible for approving the service provider. Private Providers are required to 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.
In Toronto, the Clinical Director reviews the curriculum vitae (CV) of the psychologist to identify whether these Guideline requirements are met. If the CV requires clarification, the Clinical Director contacts the psychologist and reviews training and clinical experience. In consultation with Direct Funding providers in Toronto, a consensus was developed that clinicians should have a minimum of 3 to 5 years clinical experience supervising 20 to 30 children with a variety of profiles of strengths and challenges. In the interests of capacity building, for new providers who do not quite yet meet these levels of experience, approval can be provided for supervision of 1 child in IBI, with the expectation that a Quality Improvement Review be completed early in the child’s program. A demonstrated high quality program would be expected prior to further supervision being approved.
The TPAS-DFO Providers Joint Quality Assurance Task Force (April 2013) developed a consensus document “Choosing a Quality IBI Program: Questions to ask potential IBI providers” which supports parents in selecting a high quality provider. In Toronto, families are typically contacted 2-3 months prior to a Direct Funding vacancy becoming available, and an in person meeting is held approximately 6 weeks prior to funding availability. Families are encouraged to keep vacation durations to 2 weeks in the summer, and 2 weeks in the school year to minimize the impact on skill acquisition.
Discharge Criteria
During the transition to the new OAP, children who are five years and older who are currently receiving IBI services will not be removed from services. These children will continue with their current service plans until their next regular clinical progress assessments. At that time, the Autism Intervention Program (AIP) clinician will work with the child’s family and, if the child is receiving services through the Direct Funding Option, in collaboration with the supervising psychologist of the private program to develop an individualized service plan that will bridge the child to the new Ontario Autism Program (beginning in June 2017).
The intensity of services will not be based on age or on any predetermined level. The intensity of services will be based on the child’s individual needs. The individualized service plan will provide the framework for each child’s successful transition into the new OAP. Children will transition to the new Ontario Autism Program when a space becomes available. Unless a child had an agreed-upon discharge plan in place before March 30, 2016, they will be included in the transition process as outlined in the ‘Guidelines Bridging Children from Intensive Behavioural Intervention Services to the New Ontario Autism Program, MCYS July 2016.’ Discharge plans in place prior to March 30, 2016 will be honoured by service providers.
Transition
Children currently registered or receiving services through TPAS and Toronto Autism ABA Services will transition to the new OAP in June 2017. ‘Guidelines Bridging Children from Intensive Behavioural Intervention Services to the New Ontario Autism Program, MCYS July 2016’ will support and guide decision making during this phase.
As has been the past practice for many years, clinical assessments will continue to occur at six month intervals and individual service plans will be developed in collaborations with families. Intensity of service throughout the transition will be based on this service plan. We will continue to work with the school boards to plan for school attendance.
Last year, a total of 6,326 individuals received specialized clinical services from Surrey Place Centre. Our clients come from all geographical regions of Toronto and across the lifespan, representing different ethnicities, socioeconomic statuses, gender, languages, and religions. We believe we have created a system of support that is responsive to the diverse and various needs of our clients and families.
We are dedicated to continuing and strengthening our relationships with our government and community partners, and to working together with our clients and families in order to provide the highest standards of service for those living with Autism.
Sincerely,
Steven Finlay
Chief Executive Officer