It Can Be Done: Translating Evidence Based Research into Educational Programs for Children with ASD

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It Can Be Done Translating Evidence Based
Research into Educational Programs for Children
with ASD

• Dr. B.J. Freeman, Professor Emerita,
• UCLA School of Medicine
• Dr. Ron Leaf, Co-Director, Autism Partnership
• Dr. Joanne Foland, Director of Education
  Support Services for Opportunity Schools
• Ms. Glenda McHale, Autism Programs Coordinator,
  Greater Anaheim SELPA
• 2008 NATTAP Conference
• Columbus, Ohio

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Review of Methodologies Recommended

• Simpson (2004 2005) reviewed issues and factors
  that relate to identifying and using effective
  practices with children with ASD.

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• Thirty-three commonly used interventions for
  children with ASD were evaluated and organized
  into 5 categories
• Interpersonal/Relationship-based
• Skill-based
• Cognitive
• Physiological/Biological/Neurological
• Other

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• In addition to descriptions, they also examined -
• Reported outcomes
• Qualifications of persons implementing the
  intervention
• How, where, when intervention is best carried out
• Potential risks
• Costs
• Methods of evaluating effectiveness

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• Interventions treatments were then graded as
  falling into one of four categories
• Scientifically-based practice
• Promising practice
• Practice having limited supporting information
• Not recommended

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• Interventions/treatments graded as
  Scientifically-based Practice
• Skill-based
• Applied Behavior Analysis
• Discrete Trial Training
• Cognitive
• Learning Experiences An Alternative Program for
  Preschoolers and Parents

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• Interventions/treatments graded as Promising
  Practice
• Interpersonal/Relationship-based
• Play-oriented strategies
• Skill-based
• Picture Exchange Communication System
• Incidental teaching
• Structured teaching (e.g., TEACCH)
• Augmentative/alternative communication
• Assistive technology
• Joint action routines

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• Cognitive
• Cognitive behavioral modification
• Cognitive learning strategies
• Social Stories
• Social decision-making strategies
• Physiological
• Sensory Integration

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• Interventions/treatments graded as practices
  having Limited Supporting Information
• Interpersonal/Relationship-based
• Gentle Teaching
• Options Method
• Floor Time
• Pet/Animal Therapy
• Relationship Development Intervention

10

• Skill-based
• Van Dijk curricular approach
• FastForword
• Cognitive
• Cognitive scripts
• Cartooning
• Power Cards

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• Physiological/Biological/Neurological
• Scotopic Sensitivity Syndrome
• Auditory Integration Training
• Megavitamin Therapy
• Feingold Diet
• Herb, mineral, other supplements

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• Practices Not Recommended
• Interpersonal/Relationship-based
• Holding therapy
• Skill-based
• Facilitated communication

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• Conclusion
• The field must move forward by identifying
  objectively verifiable interventions.

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What is Being Done?

• Many studies ask parents about the number of
  treatments/interventions used.
• One study (Stahmer et al, 2005) reported results
  of focus groups in community early intervention
  studies in California.

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• Most educators reported that both evidence based
  and non-evidence based programs were used.
• When evidence based programs were used,
  significant modifications were reported.
• All providers highlighted a lack of adequate
  training and preparation for teachers and
  paraprofessionals.

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• Hess, Morrier, Heflin Ivey (2008) surveyed 185
  teachers in Georgia representing 226 children
  with ASD in preschool to grade 12.
• They reported the top 5 strategies in order of
  use were

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• Gentle Teaching
• Sensory Integration
• Cognitive-Behavioral Modification
• Assistive Technology
• Social Stories

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• Less than 10 were based on scientifically
  validated practices, and 40 were not even
  mentioned in Simpsons extensive review.
• Why the discrepancy?
• Too expensive
• Lack of training

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• It can be done
• Dr. Leaf will describe evidence based programs.
• Dr. Foland will discuss issues from an
  administrators point of view.
• Ms. McHale will discuss issues of day-to-day
  implementation.

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The Law Requires a Chevy . . .

• Education should provide a
• Rolls Royce with Maserati speed.
• Dr. Joanne Foland, Director
• Education Support Services
• for Opportunity Schools

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• Cost Effective
• Best Practices
• Defensible
• Stand the test of time
• Decreased litigation

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Cost Effective

• Model Classroom for Students with ASD
• Savings to the District
• - Current cost for 8 one-to-one Instructional
  Assistants 224,000.00
• - Cost for 1 teacher and 4 one-to-one
  Instructional Assistants in the Model Classroom
  145,186.00
• Total Savings to the District78,814.00

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• Certificated
• 14,175 (insurance for certificated)
• 7,507.20 (STRS, Medicare, workers comp
  unemployment)
• Total Certificated 21,682.20
• Classified
• 28,350 (insurance for two 6-hr aides)
• 25,850 (salary for two 3¾ aides)
• Total Classified 54,200.00

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• Non-Public Agency Consultation 15,000 (11
  months of consultation services)
• Grand Total Savings to the District (or cost not
  incurred) 90,532.20

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Other Issues Solved

• Offers Students Research-Based Instruction
• Assists Teachers in Implementing Research-Based
  Practices
• Serves as a Demonstration Site
• General Staff Training
• Decreased Meetings with Angry Parents
• Reduced Staff Turnover
• Eliminate Excessive Staff
• Eventually Reduce Student Services
• LITIGATION!!!

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Validation by Outside Consulting Firm

• Exemplary and cost-effective support services for
  students with autism are in place.
• Effective program alternatives to nonpublic
  school and agency services have been developed.
• District has extraordinary programs that are
  models of what districts throughout the state
  should strive for.

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If You Build It, Will They Come?
Glenda McHale Autism Program
Coordinator Greater
Anaheim SELPA
NATTAP 2008
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A confluence of factors have intensified interest
and urgency in building effective educational
programs for children with autism.

• Public Awareness/Interest
• Litigation
• Increased Prevalence
• Impact on Education
• Research Findings

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Individuals With Disabilities Education Act (IDEA)

• IDEA ensures
• - Free, Appropriate Public Education (FAPE)
• - Supports and Services
• - Least Restrictive Environment (LRE) Ages 3-22

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Litigation

• Autism not identified as disability
• Lack of adequate assessment
• Inappropriate goals and objectives
• Failure to demonstrate adequate progress/
  educational benefit
• Failure to address behavior
• Insufficient intensity of intervention
• Inadequately trained staff
• Lack of appropriate methodologies and technical
  support
• Lack of local program development (one size fits
  all)

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Where to Begin . . .

• Research Review, Expert Input
• Determine clear, philosophical direction
• Collaboration
• Comprehensive Training
• Commitment (Buy-in)

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The Reality of . . . Having to do MORE with less

• Budgets State Federal
• -Impacts school districts, Regional Center, CDC
• Mediations and hearings
• -Time and monies
• -More is not always better
• -Reactive vs. proactive
• Staff training supervision
• Retention Recruitment
• -Burn out
• Parent support
• Educational system is responsible for all needs

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Impact on Education

• 75 of total number of cases under age 18
• Fastest growing disability
• 7,000 vs 24,000 80,000 year
• Encroachment
• Hiring, training maintaining staff
• Difficulty maintaining quality of programs and
  services as growth in prevalence exceeds capacity
• Lack of educational control/accountability
• Intensity of services for early intervention
• Building capacity preschool ? age 21/22
  (long-term planning)

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ABA ProgramTRAINING MODEL

• Didactic (2days) 12 hours _____ Written
  Exams
• Intensive Practicum (5 days) 30-40 hours _____
  Performance Rubric
• Coached Practice 60 hours _____ Assignments
  
• (60 hours)
• _____ Performance Rubric
• _____ Total
• Case Assignments Modules Assignments
• Ongoing Supervision Building Reinforcement
• Behavior/Reinforcement
• Instructions/Prompting
• Overlap Services Behavior Management Shaping
• Performance Review Staff Development
• Curriculum
• Clinics Data Collection

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ABA Program Training Model Model Classroom

• 1 Month Internship (teams)
• Highly-skilled mentor staff
• Intensive training
• Individualized

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Model Classroom Training Outcomes

• Increased staff understanding and skill
• Enhanced consultation outcomes
• Improved intervention
• Increased student outcomes
• Decreased staff stress
• Improved classroom structure, organization,
  management
• Enthusiasm, empowerment, effectiveness of staff
• Reduction in staff to student ratio
• Multiplication of training effect

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SELPA 2008

• Regional Classrooms
• Non-severe Special Education
• - Improved staff training
• - Integration of specialized instructional
  strategies and methodologies
• General Education (Inclusion)
• - Increased numbers
• Clinic-Based Services
• Consultation/Technical Support
• Capacity Building, Training, Staff Development
• Parent Education/Collaboration

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Organization of PersonnelAutism Programs
Department

• Autism Program Coordinator
  Coordinator
• SDC Autism Behavior SELPA
  NPA
• Teacher(s) Specialists Specialist Case
• Supervisor
• Assoc Assoc Assoc
• Case Case Case
• Supervisor Supervisor Supervisor
• Tutors
• Direct Line
• Field Staff

Overall Program Design, Coordination, Training,
Staff Supervision, Case Supervision, Consultation
Case Supervisor Individual Case
Development and Supervision
Associate Case Supervisors Case Management
Consultation Inclusion Support Clinic
Management
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Autism Services

• Individual Consultation
• 
  ABA Tutor Student Technical
  Regional
• 
  Mentoring ABA Support
  Program
• Staff and
  Program Coordina
• Training Super Develop
  tion
• 
  vision ment
  Satellite/District
• Collaboration
  
  Clinic
• with other
  Coordination
• SELPAs OCDE
  IEP
• Non Public
  
  Development
• Agency Coordination
  Greater and
  meeting participation
• and Liaison
  Anaheim
  
• SELPA
  Individual Case
• Autism
  Supervision
• 
  Services
  
• Capacity Building
• Due

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Outcomes

• High-Quality, Effective Programs
• Program Infrastructure
• Service Delivery Models that address broad range
  of needs
• Ongoing training and staff development
• Ongoing collaboration with experts
• Credibility in Community
• Reduction in costs
• - Reduced litigation
• - In house personnel

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Challenges

• Recruitment/Retention of staff
• Job Classification
• Secondary Education Programs
• Specialized Programs across the Spectrum
• Maintaining Quality

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The Journey Continues