Initiatives to Enhance the Service System
Standardized Best Practice Guidelines for ASD Assessment and Diagnosis
One of the most pressing needs facing families of individuals on the autism spectrum is the need for expert diagnostic services. OPWDD hears regularly from families who struggle to find the expert clinical resources to obtain an accurate assessment of their child. One factor that contributes to this situation is the fact that the focus and recommendations of the existing New York State guidelines for the assessment and diagnosis of ASDs are limited to young children between birth and age three. While these guidelines have supported the principles and practice of Early Intervention, there is no similar official guidance document for the assessment of school-age children and young adults. In addition, many of New York's pediatricians, general practitioners, non-medical assessment professionals, and other experts are not adequately informed and trained to assess for the presence of an ASD. As a group, they tend to rely on a broad range of different assessment methods. To help address this situation, OPWDD's Bureau of Behavioral and Clinical Solutions has initiated a project that will produce a set of evidence-based clinical practice guidelines for the assessment and diagnosis of ASDs during the developmental years between birth and young adulthood. This document will offer reliable information about ASDs and recommendations regarding appropriate, adequate, scientifically-supported methods of assessment that should be utilized to determine and support a valid diagnosis of ASD. OPWDD will integrate this clinical practice document into its Eligibility Guidelines advisory, provide training for OPWDD reviewers and clinicians, and disseminate it for reference and use by practitioners who assess and refer individuals for diagnostic evaluations and/or OPWDD services.
Current Status - A volunteer expert panel is reviewing and providing feedback on the existing best practice assessment guidelines published since 1999, updating the scientific research and information on which they are based, and creating an accessible document that will inform and educate practicing clinicians, OPWDD eligibility review committee members, and parents throughout New York State. A parent/caregiver survey posted online in English and Spanish for six weeks in late Fall 2010 yielded basic group demographic information and parent/caregivers' experiences and opinions regarding the diagnostic process. The panel expects to complete its work in 2011.
Delivering Intensive Behavior Services in Public Schools
OPWDD, the New York State Education Department and New York City's Department of Education are partnering to provide behavioral assessment and intervention services to students in public school settings who present with severe behavioral challenges. The program is serving students with developmental disabilities, including autism, who display severe aggression and/or self-injurious behaviors that pose a significant health and safety risk. These severe problem behaviors often cause immeasurable stress and hardship to the students and their families and place the students at risk of losing their school placement and requiring out-of-home residential services.
In this program, a clinical team of experienced, doctoral-level behavioral psychologists and post-masters level Board Certified Behavior Analysts are supplementing the expertise and resources within the schools to assess students and then develop and implement behavior intervention plans. By identifying what motivates students to exhibit challenging behaviors, the team can devise interventions that will lead the students to replace those behaviors with adaptive, functional behaviors and avert the need for more intensive service such as inpatient programs. All assessment and treatment occur in the school setting in collaboration with teachers, staff and caregivers.
Current Status - This program, which began in September 2009, is meeting with tremendous success. Students who once were likely to require residential placements are now functioning successfully in the public school classroom. Systematic evaluation of this program is being conducted, which to date reveals high levels of clinical outcomes as well as student, teacher and caregiver satisfaction with the program. Together, OPWDD and the New York State Education Department will identify best practices to deliver these kinds of behavioral interventions in school settings and to disseminate relevant information to the public, New York's school districts, and private practitioners across the State.
Campus Based Program at Consaul Road: A Center for Intensive Treatment and Stabilization Services for Adults
The Campus Based Program at Consaul Road is a statewide transitional program for adults with Autism and severe behavioral challenges. The program provides temporary, specialized services that are individualized to meet the more intensive treatment requirements for individuals with Autism whose behavioral presentation prevents placement in a less restrictive community setting. Clinical and direct support staff provide intensive behavioral supports, communication skills programming, sensory integration activities, and medication management. The program ensures ongoing active treatment through the development of effective proactive behavioral strategies, skill development plans, and intensive clinical/medical monitoring and intervention. The plan of care that is developed and in place as an individual stabilizes and approaches readiness for discharge will continue after the individual transitions back to his or her home community.
Current Status - Since 2009, the Campus Based Program at Consaul Road has supported 13 individuals in stabilizing their behavior and successfully moving on to community based services. The Campus Based Program recently admitted three individuals from different districts and they are making good progress acclimating to the Program. The Program is partnering with two different voluntary agencies to develop community based residential and day habilitation opportunities for nine individuals currently served by the Campus Based Program that are making good progress toward their discharge goals.
Positive Behavior Management Regulations
OPWDD has been developing regulations on behavior management since the 1980s. These regulations address many areas, including: development of behavior management plans, the use of personal intervention techniques (i.e. manual or physical holds as taught in the SCIP-R curriculum), the use of mechanical restraining devices, the use of time-out rooms, the use of medications to modify or control behavior, and aversive conditioning. Over the years, a variety of unforeseen obstacles have prevented the promulgation of these regulations.
Current Status - Recently, an internal Central Office workgroup led by OPWDD's Bureau of Behavioral and Clinical Solutions was convened to recommence work on the behavior management regulations and has been meeting frequently to develop a new draft. At the same time, workgroup members have been actively involved in related projects which have strongly overlapping issues that affect the content of the regulations. These include development of the PROMOTE curriculum and participation on the Interagency Restraint and Crisis Intervention Techniques Committee.
The overall goal of establishing formal behavior management regulations is to assure that for those individuals who present with challenging behaviors requiring intervention, clear standards are identified that underscore the importance of a comprehensive approach to behavior support and management and focus on prevention and early intervention at its core. Some key changes to the new draft behavior management regulations have been made that reflect the commitment the agency has made to increase the use of positive behavior supports, identify the most effective and least restrictive or intrusive intervention techniques for the modification of an individuals' challenging behaviors, and reduce reliance on the use of physical interventions while at the same time increasing monitoring, safeguarding and oversight of plans that include such interventions. These changes also reflect the agency's mission to deliver person first services in the most integrated settings possible.
Current Status - A new draft of 633.16 is nearing completion and will be shared with stakeholders from the DDSOs and voluntary providers for review and input.
In-Home Intensive Behavior Services
Intensive Behavioral Services (IB Services) is a new HCBS waiver service designed for individuals who are presently living in non-certified settings or Family Care Homes and who are exhibiting highly challenging behaviors that put them at imminent risk for placement into a more restrictive residential setting.
While the IB Services program is designed to serve people with severe behavioral issues, it is not a crisis intervention program. Thus, the primary goals of this program are:
- To help individuals who have a high need for intensive services and have the family/caregiver strength and support necessary to implement behavior plans at home,
- To effect positive change, i.e. a reduction in at-risk behaviors at home such that the individual may remain in the family setting and avoid residential placement.
IB Services are provided by licensed clinical staff that has training and experience in conducting functional behavioral assessments, developing behavior management plans, and working with people with developmental disabilities.
IB Services provide authorized individuals and agencies with time-limited funding for up to six months for behavioral supports and services. Some of the allowable IB Services include:
- Conducting relevant assessments;
- Collecting data pertinent to the challenging behaviors;
- Completion of a Functional Behavioral Assessment and development of a Behavior Management Plan;
- Implementation and monitoring of behavioral interventions and strategies specified in the Behavior Management Plan; and
- Training of the primary caregiver(s) or direct support professionals who provide services in the home, in the use of behavioral interventions and strategies that are specified in the Behavior Management Plan.
DDSOs review individuals' records on a case-by-case basis to determine their appropriateness for IB Services. To be authorized for IB services, an individual must:
- be enrolled in the OPWDD Home and Community Based Services waiver;
- live in a non-certified residential setting or Family Care Home;
- have written documentation that substantiates that the individual is at imminent risk of being placed in a more restrictive living environment due to challenging behavioral episodes;
- have a clear need for the type of services provided under the Intensive Behavioral Services model; and
- be able to benefit from the provision of Intensive Behavioral Services.
Current Status - IB Services have been implemented for a number of individuals across the state. IB Services providers attest to the continued support and interest in providing this service to individuals exhibiting challenging behaviors who are at risk for placement into a more restrictive residential setting. Satisfaction surveys and outcome measurement tools will be used to track progress and obtain feedback on the new service. More Information on IB Services
Understanding Best Practices in Supported Employment for Individuals with ASDs
To improve understanding of best practices in supporting positive employment outcomes for individuals with ASDs, OPWDD is examining the experience of the individuals with ASD who are participating in the ongoing SEMP Demonstration Project.
Current Status - Staff members within OPWDD's Center for Employment Excellence and the Bureau of Strategic Planning are currently planning the elements and timeline for this project.