Review of the Research to Identify the Most Effective Models of Practice in Early Intervention for Children with Autism Spectrum Disorders

Part 4 – Issues raised by FaHCSIA for consideration during the development of the review

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Part 4 – Issues raised by FaHCSIA for consideration during the development of the review

As this review was being developed, FaHCSIA raised several specific issues that were relevance to the review. These are outlined below.

Use of funds for diagnosis
Diagnostic assessment is not the same as assessment for program development and is therefore not to be funded as part of this package (see page 5). Intervention programs are to be developed on the basis of already completed diagnostic assessments.

One to one versus group interventions
Small group interventions may be effective; however staff:child ratios should not exceed 2:6 and each child must have an Individual Plan (IP). Generally group session fees would be expected to be less than 1:1 session fees.

Individual plans, assessment, goal setting, evaluation and review
Individual plans are fundamental to effective intervention. See Appendix C for a resource that may be useful for planning (Planning Matrix). Services should be able to specify the process they have in place for individual collaborative planning and review.

Interventions targeting one domain only, versus comprehensive interventions
Services should make clear to families whether an intervention is specific to one domain of children’s functioning (e.g. communication or play), or is more comprehensive. Comprehensive or domain specific inputs may both be appropriate, provided the family is making an informed choice.

Generic early intervention versus autism specific INTERVENTION (a)

It cannot be assumed that generic early intervention will meet principles for good practice in autism unless evidence for efficacy for ASD has been demonstrated. Unless research indicates that a generic intervention has been shown to be effective for autism it should not be considered an appropriate intervention for a child with ASD. FaHCSIA may wish to consider exceptions in particular circumstances, (e.g. isolated families where no ASD specific intervention is available).

Generic allied health versus autism intervention (b)
It is important to note that training in speech pathology, psychology or occupational therapy per se does not in and of itself ensure therapists have expertise required to work with children with autism. In addition, these services when provided by sole providers (rather than as part of a consortium or multidisciplinary team providing EI) are unlikely to meet guidelines for good practice. Individual allied health services may more appropriately be funded through Medicare. Practitioners need to provide evidence of continuing professional development in autism, or experience gained through previous work settings that enables them to provide evidence-based EI interventions for children with ASD.

Part 5 – Conclusions and Recommendations

On the basis of the evidence review (Part 2), and the input from Stakeholders (Part 3), and incorporating discussions with staff from FaHCSIA (Part 4) we have developed a set of recommendations in relation to:

improved communication and information sharing between all components and personnel involved in the HCWA Package

decisions about eligible and ineligible treatments (Table 6)

processes for regularly updating the evidence base

operationalisation of principles of good practice

revisions pertaining to evaluating and managing provider applications in a revised process for the future

need for monitoring and follow up of services

need for innovations or changes to address identified problems.

As we present these recommendations in this section, we note supporting data and the sources of these data, as derived from the review, and which underpin the rationale for the suggestions

1. Improved communication and information sharing between all components and personnel involved in the HCWA Package

Stakeholder feedback clearly indicated the need for improved communication and information sharing regarding the HCWA Package and the Early Intervention funding in particular.

Recommendations and suggestions arising from this feedback include the following:

Regular updating of the guidelines and the FaHCSIA website

Improved clarity regarding the development of service plans, purchasing resources and other issues

Improved communication between all stakeholders, particularly regarding guideline changes

Continued dissemination of information regarding all aspects of the Package, including access to information and services to assist decision making.

2. Eligible and ineligible treatments

Clarity about approved interventions

Table 6 in Part 2 informs stakeholders of eligible and ineligible interventions.

The decisions in this table take into account requests from stakeholders for approval of funding only for services that are evidence-based, goal-directed, and collaborative with families.

It is recommended that FAHCSIA circulates a list of approved interventions meeting criteria, and posts this on the internet in the interests of clearer and more universal communication to all stakeholders. Similarly, a brief outline of review methods and findings of the current review should also be on the internet site in plain language, with hard copy available on request.

The table indicates that flexibility is needed as very few of the recommended treatments have a strong evidence base and hence their eligibility rating may change as further evidence becomes available. Recommendations for processes to ensure this occurs are described in the following points.

Relevant criteria for evidence-based interventions and for good practice guidelines need to be made specific within the application process. (See operationalisation of good practice guidelines Appendix F, and recommendations for revision of panel provider application format below 6b).

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