11/18/2016. Outcomes that Matter for Adults with Autism Spectrum Disorder. Objectives: Preaching to the choir

Transcription

1 Outcomes that Matter for Adults with Autism Spectrum Disorder Kerri Erb, Chief Program Officer Louise Southern, Associate Clinical Director Objectives: Briefly review the current state of adult autism intervention services. Briefly identify and organize evidence-based practices (EBPs) for autism intervention. Review several Autism Society of NC initiatives including LifeLong Interventions, IGNITE and social recreation programs that illustrate the integration of EBPs in services Preaching to the choir Our adult population is underfunded and underserved on a national level. But services for adults are much more severely limited in comparison to available supports for the pediatric population. Individuals with Disabilities Education Act (IDEA) protections only support these learners in a public education setting until age 21. Autism intervention services (covered by private or public health insurance) often cap in early/middle adulthood. 1

2 Where does that leave our adult population? Day programs Vocational rehabilitation programs Group homes Often supported by aging parents Entering into the system in crisis/near crisis How can we all work together to prevent? Adults with autism are often less likely to seek post-secondary education and are likely under or non-employed. Studies conducted in recent years suggest: 34% of adults with ASD attended college (with even lower graduation rates). 55% of adults with ASD held paid employment positions Somewhat surprisingly, independence with activities of daily living was the strongest predictor of employment. Klinger (2016), Autism Grown Up: Supporting Positive Adult Outcomes Quality of life indicators: Increased engagement in the broader community/social context. Increased opportunities to build meaningful relationships. Increased engagement in functional behaviors reduces the opportunity for inappropriate behaviors to occur. 2

3 Given what we know Where do we go from here? We know some factors that may impact quality of life. We know what skill domains are important in addressing these factors. We look to empirical evidence for intervention and support strategies for this population Evidence-Based Practices for Autism Intervention (Wong et al., 2013) At least two high quality experimental or quasi-experimental group design articles conducted by two different researchers/groups Or At least five high quality single subject design articles conducted by at least three different researchers, with more than 20 participants across studies Or A combination of at least one experimental or quasi-experimental group design article plus at least three high quality single subject design articles, conducted by at least two researchers Antecedent-Based Intervention Cognitive Behavioral Intervention (CBI) Differential Reinforcement Discrete Trial Teaching Exercise Extinction Functional Behavior Assessment Functional Communication Training Modeling Naturalistic Intervention Parent-Implemented Intervention Peer-Mediated Instruction and Intervention Pivotal Response Training Twenty-seven EBPs (Wong, et al., 2013) Picture Exchange Communication System (PECS) Prompting Reinforcement Response Interruption Scripting Self-Management Social Narratives Social Skills Training Structured Play Groups Task Analysis Technology-Aided Instruction and Intervention Time Delay Video Modeling Visual Supports 3

4 A buffet of incompatible options? Behavior Analytic Techniques Naturalistic Behavioral Techniques Other Theoretical Influences Antecedent-Based Intervention Modeling 1. Cognitive Behavioral Intervention Differential Reinforcement (CBI) 2. Naturalistic Intervention 3. Discrete Trial Teaching 2. Exercise 3. Parent-Implemented Intervention 4. Extinction 3. Social Narratives 4. Peer-Mediated Instruction and 5. Functional Behavior Assessment Intervention 4. Structured Play Groups 6. Functional Communication Training 7. Picture Exchange Communication System (PECS) 8. Prompting 9. Reinforcement 10. Response Interruption 11. Scripting 12. Task Analysis 13. Time Delay 5. Pivotal Response Training 6. Self-Management 7. Social Skills Training 8. Video modeling 5. Technology-Aided Instruction and Intervention 6. Visual Supports Key components across ASNC initiatives: Structure and visual supports Pivotal Response Treatment (motivation, engagement, and communication behaviors are all pivotal responses for adult learners, too). Functional and social communication tools and strategies Explicit instruction (task analysis, prompting and fading, modeling, practice) Reinforcement Key strategies are similar, even when the level of need is discrepant. 4

5 The concept that individuals with autism can be lifelong learners is often eclipsed by the attention devoted to early intervention. However, it is a topic of great interest among parents of adolescents and adults with autism, and the professionals who work with them...in an informal poll, we have asked many parents of an adolescent or adult with autism at what age their children learned the most. Invariably, they respond that, regardless of the approach, the adolescent and adult years have been the times of greatest learning. -Maureen F. Morrell, Parenting Across the Autism Spectrum (Morrell and Palmer, 2006) LifeLongInterventions: The Autism Society of North Carolina introduced their Lifelong Interventions program in We currently serve individuals between the ages of 2-26* *Funding sources play a role in creating this artificial age cap. Treatment approach rooted in the principles of applied behavior analysis and include an array of evidence-based practices. Services are rendered in the individuals home and/or community Service Delivery Model: Comprehensive, Intensive Treatment Treatment planning (comprehensive, across skill domains) Rigorous data collection (used to inform treatment decisions) Parent/stakeholder training Generalization planning/training Fading and discharge planning 5

6 Three-Tiered Service Model Licensed Psychologists and Psychological Associates (LP/LPA) Doctoral level (LP) and Master s level (LPA) psychologists Conducts assessments, develops treatment and behavior support plans. Supervises the work done by the BCBA (an ancillary services provider, acting as an extension of the psychologist). Board Certified Behavior Analysts (BCBA) Master s level clinicians with advanced level training. Works under the direct supervision of the LP/LPA to assist with data collection that will inform treatment planning, teaching procedures, and data analysis. Directly supervises the work of the RBT Paraprofessionals One-on-one service providers, with specialized training in autism and applied behavior analysis. Credentialed as Registered Behavior Technicians (RBT) LifeLong Interventions video placeholder What do we see? Structure and visual supports Pivotal Response Treatment Functional and social communication tools and strategies Explicit instruction Reinforcement Autism Society of NC s Social Recreation Programs It is our belief that all individuals deserve the opportunity to take part in outdoor recreation programs The camp experience is a rite of passage in our country and we feel that individuals with autism deserve to experience all of the wonderful things that a camp environment has to offer 6

7 History of ASNC Recreation Programs ASNC started a summer camp program in 1972, with 6 kids and families Camp Royall opened in 1997 Year Round Programs at Camp Royall began in 2009 In we served over 2000 individuals and their family members in all of our year round camp programs at Camp Royall and in Eastern NC camps Goals of Social Recreation Programs: Recreational experiences Therapeutic and educational experiences Respite for families Training for students and professionals Key ingredients: 1:1 or 1:2 staff to camper ratio Typical camp activities Emphasis on structure and visual support Highly talented and well trained staff members 7

8 Eastern Region Social Recreation Programs CARTERET COUNTY WILMINGTON GREENVILLE On the horizon: Social groups and opportunities for young adults Parent and chapter engagement Possible expansion - Increased weeks in summer 2017 Social Recreation video placeholder What do we see? Structure and visual supports Pivotal Response Treatment Functional and social communication tools and strategies Explicit instruction Reinforcement 8

9 Peer to peer community center for adults 18 years old and up with HFA/Asperger s Emphasis on member buy-in to improve social skills, employment, and seek to move toward independence Group instructional format, with individualized support as needed 73 current members in various levels of participation IGNITE workshops and group instructional activities: Employment and vocational Peer to peer social engagement Wellness/health/safety Community involvement Education Parent support group Key ingredients: IGNITE functions as a partnership between staff and members Members are encouraged to support one another Activities determined by members' preferences and requests. IGNITE's website and blog will be developed by members, for members. Workshops and individual coaching determined by the members' needs 9

10 Placeholder: IGNITE 5 th Cut video segment Achieving outcomes that matter through lifelong learning Increased engagement in the broader community/social context. Increased opportunities to build meaningful relationships. Increased engagement in functional behaviors thereby reducing the opportunity for inappropriate behaviors to occur. 10

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