Autism Services in Canada: Mapping a lifespan strategic plan - - PowerPoint PPT Presentation

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Autism Services in Canada: Mapping a lifespan strategic plan - - PowerPoint PPT Presentation

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Autism Services in Canada: Mapping a lifespan strategic plan Presenter(s): Michle L. Hbert, PhD, OT Louise Burridge, BScH; BScOT; MEd Jonathan Lai, PhD CAOT Professional Issue Forum May 7, 2020 Canadian Association of Occupational

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CAOT Professional Issue Forum

Association canadienne des ergothérapeutes Canadian Association of Occupational Therapists

Autism Services in Canada: Mapping a lifespan strategic plan

Presenter(s): Michèle L. Hébert, PhD, OT Louise Burridge, BScH; BScOT; MEd Jonathan Lai, PhD

May 7, 2020

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A bit about the panelists ...

Jonathan Lai Michèle L. Hébert Louise Burridge

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Forum Outline

  • Forum Objectives
  • 15-Minute Presentation per Panelist
  • Consensus Appraisal Process

– Reflection Questions – Warm-up – Reflection Questions – Breakout rooms – Reflection Questions – All together

  • Next Steps
  • Questions and Comments
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Forum Objectives

Develop a shared pan-Canadian vision

  • Collect jurisdictional perspectives on OT access
  • Define the ideal positioning of OT in the

care continuum for people with autism

  • Identify practice resources
  • Propose advocacy actions

Ultimately, implement a powerful, empowering consensus strategy

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Reflection Questions – Warm-Up

Click on: … Mentimeter link … When you are connected to Mentimeter, give a

( is found by clicking on Participants at bottom of Zoom)

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Reflection Questions – 1 of 6

1- What primary province/territory do you work in?

Alberta​ Ontario​ British Columbia​ Prince Edward Island Manitoba​ Quebec New Brunswick​ Saskatchewan Newfoundland and Labrador​ Northwest Territories Nova Scotia​ Nunavut or Yukon

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Reflection Question 2 of 6

2- What primary age group do you work with?

  • Infants (Birth to 12 months of age): ______
  • Toddlers (13 to 36 months): ______
  • School-age children (37 months to 12 years): ______
  • Teens (13 years to 15 years): ______
  • Youth/young adults (16 to 21 years): ______
  • Adults (22 to 64 years): ______
  • Elderly (65 years or more): ______
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Reflection Question 3 of 6

3- What primary setting do you practice in?

  • Public sector clinic setting (i.e., hospital, rehabilitation centre): ______
  • Private sector clinic setting (i.e., private clinic): ______
  • Non-profit/charity sector (i.e., community organization): ______
  • Other (please specify): ______
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Reflection Question 4 of 6

4- What type of funding source(s) cover

  • ccupational therapy services in this setting?
  • Public
  • Private
  • Mixed
  • Other (please specify): _______
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Reflection Question 5 of 6

5- How many years of occupational therapy experience working with people with autism spectrum disorder do you have (less time on leave)?

0 years 100 years

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Reflection Question 6 of 6

6- Please help us learn about what funding resources or programs in your province/territory. Answer only for the province/territory in which you primarily practice (see next slides). Province + Resource/Program + Amount ($) + comments

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Reflection Question 6 of 6 - Funding

Province/Territory Funding Resource/Program Alberta Family Support for Children with Disabilities (FSCD) British Columbia Up to $22,000/year per child under age 6 years Up to $6,000/year per child 6 to 18 years Manitoba Children’s Disability Service under age 18 years Children’s Therapy Initiative (anyone up to the age of 21 who has a developmental concern). New Brunswick 20 hours/week of intensive intervention for preschoolers Family Support for Children with Disabilities under age 18 years Nova Scotia Early Intensive Behavioural Intervention Treatment for preschoolers - 15 hours/week for 1st 6 months, then reduced

  • ver next 6 months

Direct Family Support for Children (respite) up to $2,200/month for home caregiver 0 to 19 years Newfoundland and Labrador Intensive Applied Behavioural Analysis Program for preschoolers, up to 30 hours/week; for kindergarteners & Grades 1-3, up to 15 hours/week

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Reflection Question 6 of 6 - Funding

Province/Territory Funding Resource/Program Northwest Territories Autism program for therapy intervention birth to 6 years Autism program for aides & other school services over age 6 years Nunavut Income assistance through the territory’s Family Service’s department (not specific to autism) Ontario $20,000/year under age 6 years $5,000/year ages 6 to 18 years Prince Edward Island Autism Early Intervention Program for preschoolers up to 25 hours/week & $200/week for material School-based autism assistant & private one-on-one tutor for

  • ut-of-school for school-aged children

Quebec Autism Action Plan ages 2 to 5 years $83 million to hire more school professionals Saskatchewan Up to $4,000/year under age 6 years Yukon Services to Children with Disabilities program for therapy, respite, childcare, medical travel and AXs - ages birth to 19 years

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Evidence Across the Lifespan

Michèle L. Hébert, Postdoctoral Fellow, University of Calgary

  • About identifying autism
  • State of evidence-based knowledge

– Infants and toddlers – Children and teens – Youth – Adults (more from Louise)

  • Coordinated care and Systems navigation
  • Continuum of care
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Identifying Autism

  • Is early diagnosis best?
  • Needs-based or diagnosis-based?
  • Teasing out autism, sensory processing and

mental health

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Evidence-Based Knowledge

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Infancy and Toddlerhood

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Childhood and Teens

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“Supports Cliff”

www.OnTracBC.com

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Youth Moving Out?

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Adulthood and the Elderly

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Coordinated Care

  • National and provincial guidelines
  • Examples of implementation
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Systems Navigation

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Systems Map

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Continuum of Care: Role of OT

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Continuum of Care: Occupation

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Acknowledgements

Images

  • www.Burst.Shopify.com
  • www.Pixabay.com

References

  • Bronfenbrenner, U. (2009). The Ecology of Human Development: Experiments by Nature and Design. Cambridge,

Massachusetts: Harvard University Press. ISBN 0-674-22457-4.

  • Freeman, H.P., & Rodriguez, R.L. (2011). History and principles of patient navigation. Cancer, 117(S15), 3537-

3540.

  • Geurts, & Vissers (2012). Elderly with Autism: Executive Functions and Memory, Journal of Autism and

Developmental Disorders, 42:665–675

  • Hodgetts, S., Zwaigenbaum, L., Nicholas, D., & McConnell, D. (2013). Connecting the Dots: Navigating Systems of

Care for Young Persons with Autism Spectrum Disorder in Alberta: Final Report. Alberta Centre for Child, Family and Community Research, Edmonton, p. 4.

  • Lind, C. (2012). www.DurgasToolBox.com
  • Luke, A., Doucet, S. & Azar, R. (2018). Paediatric patient navigation models of care in Canada: An environmental

scan, Paediatrics & Child Health, 23(3):e46-e55.

  • Wong, C., Odom, S.L., Hume, K.A., Cox, A.W. et al. (2011). Evidence-Based Practices for Children, Youth, and

Young Adults with Autism Spectrum Disorder: A Comprehensive Review, Journal of Autism and Developmental Disorders, 45:1951–1966.

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Evidence- Based Predictors for Post-School Success

  • Research on outcomes in adult life for individuals living with

an autism spectrum disorder (ASD) is growing, but findings remain inconsistent and often conflicting.

  • While considerable investments have gone into research,

development & implementation of early childhood interventions to support development, adults with ASD have had extremely poor outcomes in adulthood – especially in regards to employment.

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Exploring Outcomes For Adults with ASD

To date, overall outcomes for adults with ASD in terms of:

  • Employment;
  • Relationships;
  • Independent Living; and,
  • Mental health

Are considerably poorer than for same-age peers.

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Improving Outcomes

  • Improving employment outcomes

for those living with ASD is an important policy objective. Work

  • pportunities improve quality of

life, cognitive functioning, and the

  • verall well-being of persons living

with ASD (Walsh, Lydon, & Healy, 2014).

  • Employment offers the
  • pportunity for economic self-

sufficiency, financial security, independent living, participation in the community, and increased self-esteem (Joshi, Bouck, & Maeda, 2012).

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Poll Question

  • Which of the following factors

predict long-term outcomes for individuals on the autism spectrum?

  • A. Intellectual Disability
  • B. Executive Functions
  • C. Independence with

Daily Living Skills

  • D. Severity of

diagnostic characteristics

(Bishop-Fitzpatrick, 2016)

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8 Predictors of Post-School Success

COLLABORATIVE NETWORKS INDIVIDUALIZED CAREER DEVELOPMENT COMMUNITY BASED WORK EXPERIENCE SOCIAL SKILL INSTRUCTION WITHIN AUTHENTIC ENVIRONMENTS

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8 Predictors of Post-School Success

SELF-DETERMINATION INCLUSIVE PRACTICES & ENVIRONMENTS ACADEMIC, VOCATIONAL AND OCCUPATIONAL EDUCATION AND PREPARTION SUPPORTIVE PARENTAL INVOLVEMENT & EXPECTATIONS

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Role for Occupational Therapy?

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References

Bishop-Fitzpatrick, L., Hong, J., Smith, L. E., Makuch, R. A., Greenberg, J. S., Mailick, M. R. (2016). Characterizing Objective Quality of Life and Normative Outcomes in Adults with Autism Spectrum Disorder: An Exploratory Latent Class Analysis. Journal of Autism Developmental Disorders, 46(8), 2707-2719. Gilotty, L., Kenworthy, L., Sirian, L., Black, D. O., & Wagner, A. (2002). Adaptive skills and executive function in autism spectrum disorders. Child Neuropsychology, 8(4), 241-248. Joshi, G., Bouck, E. & Maeda, Y. (2012). Exploring employment preparation and post-school

  • utcomes for students with mild intellectual disability. Career Development and

Transition for Exceptional Individuals, 35(2), 97-107. Walsh, L., Lydon, S. & Healy, O. (2014). Equipping youth with autism spectrum disorders for adulthood: Promoting rigor, relevance, and relationships. Remedial and Special Education, 20(10), 1-11.

Acknowledgements: Image on Slide 27:

  • https://www.npr.org/sections/health-shots/2014/12/19/371679655/some-early-childhood-experiences-shape-

adult-life-but-which Images on Slide 29:

  • https://local.theonion.com/man-spends-long-day-at-work-waiting-to-go-home-and-be-l-1831209736
  • http://www.thedistilledman.com/making-guy-friends-as-a-man/male-friendship/
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CAOT Professional Issue Forum

Association canadienne des ergothérapeutes Canadian Association of Occupational Therapists

National and International Advocacy in Autism

Jonathan Lai Director of Strategy and Operations Canadian Autism Spectrum Disorder Alliance (CASDA)

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A National Strategy requires…

Understanding the Needs Stakeholder Consultation and Prioritization Policy Options and Alternatives

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National Needs Assessment

  • Various predictors impact need, unmet

need, and receiving specific services – clinical severity, ethnicity, education, geography

  • Caregiver report (n = 3317)
  • asked about current service receipt,

top 5 current needs

  • bivariate analysis and Poisson

regression by age group

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Getting your priority needs met

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A National Strategy requires…

Understanding the Needs Stakeholder Consultation and Prioritization Policy Options and Alternatives

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Policy Consultation

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Policy Options

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A National Strategy requires…

Understanding the Needs Stakeholder Consultation and Prioritization Policy Options and Alternatives

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Right-based approaches

  • Convention on the Right of

Persons with Disabilities (CRPD)

  • Protections

– Federal (Canadian Human Rights Commission) – Provincial/Territorial

  • Promotions

– Domestic and International Monitoring – "progressive realization"

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Looking forward

  • Roadmap for National Autism

Strategy – www.casda.ca – Inter-Governmental Relations Tables: FPT – Working Groups and Advisory Panels

  • Role of professional

groups/associations – Policy briefs with CASDA: evidence-informed standards

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Reflection Question 7 of 12

7- In 5 years from today, what is the ideal scenario for occupational therapy services across Canada?

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Reflection Question 8 of 12

8- Please list 5 practice resources that are needed to actualize this ideal scenario.

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Reflection Question 9 of 12

9- List 5 concrete actions that CAOT, in partnership with organizations like CASDA, can do to reach this ideal scenario? This process will inform benchmarks and actions for CAOT with the Government and other stakeholders.

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Reflection Question 10 of 12

10- List 1 or 2 concrete actions that you, as an

  • ccupational therapist, can do to reach this ideal

scenario? This process will inform benchmarks and actions for occupational therapists with relevant stakeholders.

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Reflection Questions 11 and 12

Last 2 questions for 4 audiences:

  • Fellow occupational therapists
  • Parents/caregivers/families
  • Other professionals
  • Policy makers
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Reflection Question 11 a, b, c, d

When reflecting on the unique contribution of

  • ccupational therapy for people with autism...

11- what key message do we want to share with:

11a) fellow occupational therapists? 11b) parents/caregivers/families living with people who have ASD? 11c) other professional disciplines? 11d) policy makers?

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Reflection Question 12 a, b, c, d

When reflecting on the unique contribution of

  • ccupational therapy for people with autism and

the key message per audience/stakeholder group... 12- what educational tool* do we want to use to help:

12a) fellow occupational therapists demonstrate the unique ... 12b) parents/caregivers/families understand the unique ... 12c) other professionals appreciate the unique contribution of OT 12d) policy makers make decisions based on the unique ... *: Facebook, Twitter, Instagram, Email, Video clip, Infographic, other

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Next Steps

  • Panelists' Manuscript
  • CAOT Report
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Questions and Comments?

Michèle L. Hébert president@BudsinBloom.org or Michele.Hebert@UCalgary.ca Louise Burridge louise@outcomestherapy.com Jonathan Lai jlai@Casda.ca THANK YOU VERY MUCH!

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