ASA's 37th National Conference on Autism Spectrum Disorders (July 13-15, 2006)

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Friday, July 14, 2006: 10:45 AM-12:00 PM
551 A-B
#2141- Pivotal Response Treatment (PRT) in Nova Scotia: A community-based early intervention model
This presentation will describe the rationale for a novel early intervention model for children with autism. We will outline essential components of Pivotal Response Treatment (PRT, an empirically-supported behavioural intervention), and two aspects of the model of service delivery: (i) training teams of parents and service providers in PRT, and (ii) implementation of the model. The evaluation plan, covering both training and implementation aspects (including monitoring of the fidelity of treatment implementation and assessment of child outcomes), will be presented.

Presenters:Daniel Openden, PhD, Koegel Autism Center, Associate Specialist and Head of Community Training - Dr. Daniel Openden received his doctorate in Education with an emphasis in Special Education, Disability, and Risk Studies at University of California, Santa Barbara. Dr. Openden has worked extensively with families with children with autism on federal and state funded research projects; provided consulting and training for school districts across the country; presented research at regional, state, and national conventions; and has been published in professional journals in the field. His research interests include parent education, professional development, positive behavior supports, early intervention, inclusion, and service delivery models for children with autism.

Susan E. Bryson, PhD, Dalhousie University, Professor and Craig Chair in Autism Research - Dr. Susan E. Bryson is a leading authority on early detection of autism, and on mechanisms of attention and emotion in autism. Widely-published, she also serves on editorial boards for the Journal of Autism and Developmental Disorders and Journal on Developmetntal Disabilities, and has been a featured speaker at many national and international conferences. She has consulted to Health Canada, U.S. Centers for Disease Control, and provincial governments, and is currently Project Leader for a province-wide early intervention program in Nova Scotia. She received the Queen’s Golden Jubilee Medal in 2003 for outstanding contributions to the autism community.

Isabel M. Smith, PhD, Dalhousie University, Assistant Professor - Dr. Isabel M. Smith is a Clinical Psychologist whose research addresses perceptual-motor and cognitive development (especially imitation skills), and developmental course and outcomes in ASD. Dr. Smith’s clinical expertise is in the diagnosis and assessment of ASD. Her clinical work has also focussed on the promotion of evidence-based practices for the assessment and treatment of children and youth with ASD. She has provided training and consultation to clinical teams, and presented extensively to diverse parent and professional audiences. Dr. Smith’s contributions to the Canadian autism community were recognized in 2003 by a Queen’s Golden Jubilee Medal.

Robert Koegel, PhD, Koegel Autism Center, University of California, Santa Barbara, Professor and Director - Dr. Robert L. Koegel is internationally known for his work in autism, specializing in language intervention, family support and school inclusion. He has published extensively, including over 150 articles and five books on autism treatment and positive behavioural support, and has received major research and training grants from national agencies. He has trained many health care and special education leaders in the US. Models of his procedures have been used in public schools and parent education programs both nationally and internationally.

Lynn Kern Koegel, PhD, Koegel Autism Center, University of California, Santa Barbara, Clinical Director of Autism Services - Dr. Lynn Kern Koegel has been active in the development of programs to improve communication in children with autism, including the development of first words, development of grammatical structures and pragmatics. She is co-author and co-editor of major textbooks on autism and positive behavioural support and co-author of the best-selling Overcoming Autism: Finding the answers, strategies and hope that can transform a child’s life. In addition to published books and articles, she has developed widely-used manuals on self-management and functional analysis, and is actively involved in providing services in school districts through the US.

Early intensive behavioural intervention programs for children with autism have been widely implemented throughout the U.S. and elsewhere. However, while much has been documented about best practices, very little is known about the effectiveness of transferring evidence-based university treatment models to community-based treatment models, or whether or how they conform to best practices.

Learning Objectives: Following this presentation, learners will gain an appreciation of the important considerations in developing and implementing a community-based model of early intervention for children with ASD. This will be exemplified through a description of a program in which PRT, an empirically supported treatment developed and implemented in California, is being disseminated to and established in Nova Scotia, Canada. Specifically, learners will appreciate: 1. (a) the need for a feasible, sustainable model of service delivery, and (b) the rationale for two aspects of the model of service delivery: (i) training teams of parents and service providers (ii) implementation of model, and will be able to: (3) describe the critical characteristics and intervention procedures of PRT (4) describe the essential training components for transferring an empirically validated treatment from a university-based to community-based model (5) describe the evaluation plan for the (i) training of teams of parents and service providers (ii) implementation of the model (including monitoring of both treatment fidelity and child outcomes).

This presentation will describe a novel, community-based model of early intensive behavioural intervention (EIBI) for young children with autism. We will include a description of (i) the treatment and service delivery models, (ii) training in treatment implementation, and (iii) the evaluation plan. Pivotal Response Treatment (PRT), an evidence-based treatment model (Koegel & Koegel, 2005), is being implemented as a publicly provided service throughout Nova Scotia in both urban and rural communities. Based on best practices, the service delivery model encompasses a coordinated, cross-disciplinary team. The team includes parents and all service providers (interventionists, psychologists, speech and language pathologists and occupational therapists) involved in the care and treatment of each child. We will outline the rationale for adopting PRT, as well as its essential components. In this context, discussion will focus on the importance of optimizing the development of social-communication abilities, and on generalization and self-initiated interactions in children with autism (Lord & McGee, 2001). We will also address the critical issues of parent involvement, team coordination, shared values, and strong leadership, and of how our service delivery model has been designed to optimize the transfer of treatment gains demonstrated in more controlled university-based contexts to community settings.

Our service delivery model includes a major training component with comprehensive follow-up. We will describe two critical aspects of this training: (i) training of parents and service providers in implementing PRT, and (ii) training of trainers in PRT, and the process by which each of these are being achieved. Both aspects of training are aimed at optimizing treatment fidelity and maintenance of gains, as well as feasibility and sustainability of our treatment model. Trained trainers in PRT will provide us with the capacity to train not only new families and EIBI service providers, but also daycare, preschool and school staff involved in the early education of children with autism.

We will also describe the evaluation plan, which covers both the training and implementation aspects of the program. Training of parents and service providers will be evaluated with respect to trainees' understanding of key concepts and fidelity of treatment implementation, as well as social validation measures. Comparable measures will be used to evaluate the training of trainers in PRT. The EIBI program evaluation plan includes monitoring of child outcomes for the cohort of children enrolled in this phased-in provincial program. Critically, the plan for assessment of child outcomes will include not only standardized tests of cognitive, language and adaptive skills, but also qualitative measures of child-parent engagement and affect.

Care has been taken both to incorporate best practices in our treatment and service delivery models and to address critical outstanding research questions. In so doing, the present work promises to advance understanding of how these goals can be accomplished within the context of community-based services aimed at bettering the outcomes of children with autism and their families.

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