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


Membership of the HCWA EI Provider Panel



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1.2 Membership of the HCWA EI Provider Panel

There are a myriad of proposed treatments for autism, many of which have little or no scientific evidence to guide decision-making. The quality of proposals seeking service provider status has been highly variable and poses significant challenges for those responsible for making decisions about eligibility for membership of the HCWA EI Provider Panel.

The process for evaluation of applications for service provider status involves consideration of the following criteria for assessing program proposals:

Scientific Merit, including both:


    • Type 1 research evidence. This is research directly evaluating outcomes of specific programs, and

    • Type 2 research evidence. This is research into the characteristics of ASD which informs us about how likely it is that the intervention will be effective, based on our knowledge of the condition.

Evidence of adherence to principles of good practice for early intervention generally and for autism intervention more specifically. These are particular characteristics of interventions that contribute to successful outcomes for children with ASD and their families.

More detail is provided in the following section.


1.2.1 Scientific merit

In order to identify the best outcomes as evidenced in the literature and also best value for money, we have reviewed research on treatments published from 2005 to 2011, from a scientific point of view to identify and assess evidence about what is likely to work.

A study is described as having scientific merit when the design and execution of the research is of a sufficient quality to enable independent scholars to draw firm conclusions about treatment efficacy from the results.

Methodology for Scientific Merit Rating Scale


In this review we have used the Scientific Merit Rating Scale (SMRS) developed by the United States’ National Autism Center for the National Standards Report (2009). The SMRS involves rating the research into outcomes of interventions along five critical dimensions of experimental rigour. These ratings are then combined and an overall scientific merit score is obtained which indicates the extent to which interventions can be considered to be effective. The five critical dimensions considered when determining the SMRS score are:


research design

measurement of the dependent variable

measurement of the independent variable or procedural fidelity

participant ascertainment

generalisation.
For detail about the SMRS and process followed for this review see Appendices D and E.

Limitations


There are two key limitations to the SMRS process as applied in this review. These are:

Amount of evidence

There is some reliable evidence for a small number of interventions (see summary of systematic reviews, Appendix A, and our own SMRS tables, Appendix E). However the clear majority of interventions rated under this review do not have a scientific evidence base. As a result, Type 2 evidence (i.e. “Does the proposed intervention make sense in light of what is known about autism?”) needs to be considered. Consideration needs to be given as to how well the intervention addresses principles of good practice in early intervention and autism. In order to do this, reliable objective information about the intervention is required. This is not always available. Therefore one of the recommendations of this review is to clarify the extent of the information that should be provided in provider panel applications to enable evaluation of the application.


Intensity

The second limitation concerns the intensity of the interventions described as established in the research literature. These are almost all designed to be delivered at higher levels of intensity and have been evaluated at higher levels of intensity than is probably possible with public funding alone. As a result, the level of intensity at which an ‘established’ intervention is implemented and evaluated needs to be considered. It cannot be assumed that the same findings would be made if the intervention is implemented at lower levels of intensity.


1.2.2 Principles of good practice


The previous review (Roberts & Prior 2006) and the subsequent Good Practice Guidelines (Prior & Roberts 2006) provide the core criteria for judgement of the suitability of interventions (along with any modifications stemming from this review).

These guidelines will remain as core criteria for judgement of the suitability of interventions along with any modifications stemming from this review.


Key elements of effective interventions


The Good Practice Guidelines lists the following as key elements of effective interventions.

autism specific program content providing highly supportive teaching environments and generalisation strategies

supporting the need for predictability and routine

a functional approach to challenging behaviours

transition support

use of visual supports

sufficient intensity

multidisciplinary collaborative approach

inclusion of typically developing peers

focus on independent functioning

addressing obsessions and rituals.

These principles of good practice and elements of effective intervention are explained more fully in Appendix F.

The objectives of this review process are that:




families should be in a better position to obtain the best possible available interventions for their children given the constraints of geographic location and service availability

FaHCSIA has up-to-date information and guidance about the evidence for efficacy of interventions and about interventions based on current best practice for children with ASD and their families.







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