Autism Services Evaluation 1

Running head: EVALUATING AUTISM SERVICES AT TVCC

Evaluation of Thames Valley Children’s Centre Autism Services

Anam Shuaib

Brescia University College

Autism Services Evaluation 2

About Thames Valley Children’s Centre

Thames Valley Children’s Centre was established in 1949, as the “London and

District Crippled Children’s Treatment Centre”. However, during the 1970’s the Centre

changed its name to Thames Valley Children’s Centre (TVCC) to reflect the growth of

regional programming and the shift in societal attitudes towards children with disabili-

ties.

Initially, the Centre provided physical therapy and nursing care to victims of polio,

but as polio disappeared, the Centre expanded its programming to a wide range of dis-

abilities such as physical disabilities, communication disorders, developmental delays,

and autism spectrum disorders; today it serves more than 5,500 children from pre-birth

to young adulthood throughout Southwestern Ontario.

Among some of the Centre’s achievements are innovating “the first multi-specialty;

multi-disciplinary clinic for individuals with spina bifida in Canada; the first program pro-

viding continuity of treatment for neurosurgical patients and children with closed head

injuries; and a pioneering change to program management” (History, 2010).

The Centre’s missions is to “provide rehabilitation services which support participation in

all areas of life for children, youth and young adults with physical, communication or de-

velopmental needs, and their families, living primarily in Southwestern Ontario” (Mis-

sion, Vision and Values, 2010).

The centre serves as a hub with 67% of its programming that travel to the chil-

dren and are delivered in over 400 settings (not including homes) such as schools, day-

cares, recreational settings, hospitals and other organizations. The centre also has part-

Autism Services Evaluation 3

nerships with more than 20 school boards, healthcare organizations, and community

agencies. (TVCC: The facts, 2010).

The programs and services offered at TVCC include Specialty Clinics, Physio-

therapy, Occupational Therapy, Intensive Behavioral Intervention, School Support Pro-

gram- Autism Spectrum Disorder, Service Coordination, Specialized Learning Assess-

ments, Speech Language Pathology, Vocational and Live planning, Community Devel-

opment, Individual and Family Counseling, Information, Education and Resources,

Equipment Services, Augmentative Communication, Seating, Mobility, Adaptive Tech-

nology, Leisure, Recreation and Fitness. (Beyond Disability, 2010).

For the purpose of this paper, I will mostly be focusing on critically evaluating

autism spectrum disorder treatment programs, and related services offered at TVCC.

Autism is a neurological dysfunction marked by a wide range of disabilities such

as problems in social development, delayed or unusual language or communication

skills and repetitive or ritualistic behaviors (Autism Intervention Program, 2010).

Referral to Autism Services and Programs

Referral to Autism Services at TVCC can be made by anyone; however, a con-

firmed medical diagnosis is required in order for the child to be seen for assessment. El-

igible children diagnosed with autism at the severe end of the spectrum qualify for many

highly individualized programs and services at TVCC such as Parent Education Work-

shops, Social Work Support, Service Coordination, Child-Specific Clinical Consultation,

Intensive Behavioral Intervention, Transition to School and Community Support. Fur-

thermore, Children deemed ineligible to receive the above mentioned services are not

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simply turned away; TVCC goes up and beyond to help redirect these families to other

TVCC services and community programs.

The Autism Programs at TVCC includes two different services (Intensive Behav-

ioral Intervention and School Support Program) sharing a common foundation in Ap-

plied Behavior Analysis (ABA).

ABA is a method of analyzing what happens right before a behavior occurs, what

the behavior entails and then what consequences take place right after the behavior. In-

terventions are then developed tailored to the needs and strengths of the child to reduce

negative behaviors and develop more positive behaviors through positive reinforcement.

ABA has been proven to be most effective for children with Autism Spectrum Disorders

(ASD) and is backed by evidence based strategies supported by empirical research

(Autism Intervention Program, 2010). The goal of the Autism programs at TVCC is to

help children achieve the highest level of independence, become part of their communi-

ties and to continue improving even after they are no longer enrolled in the program.

Intensive Behavioural Intervention Outcome and Unfortunate Issues

The Autism Intervention Program at TVCC provides Intensive Behavioral Inter-

vention (IBI) to children diagnosed with autism at the severe end of the spectrum. Ac-

cording to The Ontario Association for Behaviour Analysis (2006) IBI is considered the

“best practice” for young autistic children when compared to other less intensive inter-

ventions, special education and eclectic intervention. Outcome studies have shown sig-

nificant statistical and clinical reductions in autism symptoms, approximately 50% of the

children in IBI program improve enough to fall into a milder spectrum of autism at the

time of exit compared to their initial scores. Out of individuals “who were in the mild/

Autism Services Evaluation 5

moderate autism range at intake, 41% improved so that they were in the non-autism

range at exit. Of those in the severe autism range at intake, 59% improved to the mild/

moderate range and 15% improved very substantially to the non-autism range” (Perry et

al., 2006).

The study also emphasized that those children who started IBI before the age of

four did better on all scores on the exit assessment than those who started later (Perry

et al., 2006). Furthermore, research has established that autistic children who develop

some speech and communication skills prior to school age have a superior prognosis

than those who do not (Chaban, 2005).

Given that, there is a great pressure to develop these skills promptly after a child

has been diagnosed with autism. Unfortunately however, the cost of IBI is not covered

by Ontario’s Health Care Plan, instead, the parents must either pay for the treatment

privately which can cost up to $60,000 per year or apply for funding through The Min-

istry of Children and Youth Services (MCFCS) and be wait-listed for 3-5 years. This long

delay can gravely compromise the outcome benefits of this essential intervention direly

needed during the sensitive periods of development (Perry, 2002).

During 1999, MCFCS launched initiatives to provide early IBI treatment to autistic

children aged 2 to 5 years but after reaching the cut-off age of 6, children were simply

terminated from IBI treatment. The government of Ontario removed this age restriction

policy in 2007 and introduced bench marks that qualified children and youth at the se-

vere end of the autism spectrum to receive IBI until they have either maxed out on ben-

efit or are not benefitting from it any longer (Perry, 2002).

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The down side of this policy is that the funding hasn’t increased enough to reflect

the increase in case loads, the case loads are full because children are staying longer in

the program and as a result, wait times have increased for new clients. This has serious

repercussions for newly diagnosed young children who may not be able to get the inter-

vention during their sensitive periods of development (Ziegner, 2010).

The government needs to step up and amend provincial healthcare insurance

plans to include IBI. If not, then MCFCS is discriminating against the mentally disabled.

Without adequate treatment, autism can remain a lifelong dysfunction; which in the long

run, results in approximately 90% of these individuals being eventually placed in resi-

dential homes and institutional facilities living an unfulfilled life and being depended on

governmental support (Deskin, 2005). Overtime funding IBI pays off because the treat-

ment provides these individuals with a better chance at life, career and a lesser proba-

bility of being placed in an institution and therefore, the tax money that would have oth-

erwise been spent on supporting these individuals could be saved and redirected to-

wards funding IBI.

Wait-list Strategy at Thames Valley Children’s Centre

On a brighter note, The Autism Program at Thames Valley Children’s Centre has

the shortest waitlist in all of Ontario (1 year waitlist as opposed to 3-5 years). TVCC has

developed remarkable Parent Education Workshops, Community Resources, and Child-

specific Clinical Consultation (CCC) sessions for families waiting for IBI to begin. These

workshops are designed to teach parents the basic principles and strategies of ABA to

help the child learn new skills. The purpose of CCC is to help parents apply ABA princi-

ples learnt from the workshop to the child’s behaviors and learning. Most of TVCC ther-

Autism Services Evaluation 7

apy rooms have a one way mirror so that parents can observe the child in a variety of

settings in order to understand and be responsive to the child’s strengths and needs.

TVCC staff works very closely and collaboratively with parents so that the parents will

acquire the knowledge, skills, and confidence needed to execute effective behavioral

teaching strategies to help their child learn new skills, and to empower parents to man-

age their demanding behaviors (Ziegner, 2010).

According to Vanderborght, the director of The Autism Program at TVCC, this

train-the-trainer approach to ABA often encourages parents to opt out of IBI waitlist be-

cause the workshops and Child-specific Consultations allow the parents to master how

to apply ABA techniques and implement IBI on their own. As a result, TVCC is able to

keep the waitlist short. However, empirical evidence is needed to determine the effec-

tiveness of self-learning. Verspagen, the Service Coordinator at TVCC mentioned that

another reason why parents opt out of the waitlist is because during this wait time par-

ents often realize that the IBI program at TVCC is very intensive and fulltime; and

hence, parents often decide that it’s best for their child to continue learning at school in-

stead of switching to full time Intensive Behavioral Intervention.

Parents who choose school over IBI still receive quality care and services at

TVCC. TVVC provides these families with Child-specific Clinical Consultation (CCC)

staff who continue working with the family for up to a year; during this time TVCC also

helps these families advance their ABA skills with the child, at home and in the commu-

nity. Furthermore, ASD consultants join the team support to work with the child’s

teacher and school to apply the same ABA principles at school. TVCC’s ASD consul-

tants also provide customized training, tailored consultation for educators, resource de-

Autism Services Evaluation 8

velopment and links to community agencies. ASD consultants collaborate with boards to

develop training plans and ways to incorporate ABA principles into school board prac-

tices. TVCC extensive School Support Program has partnerships with twelve school

boards and one provincial school.

TVCC stays committed to enhancing the individual’s capability through system-

atic ways of teaching new skills. However, a depressing possibility for parents opting out

could be because IBI services require weekly parental involvement and some parents

might not have the time or be motivated enough to participate in their child’s treatment

program.

Parents who do decide for their child to receive IBI receive 25-30 hours of inter-

vention spread over a week for a maximum of three years, IBI is most effective in the

first two years but there are some children who do not benefit from IBI al all.

Six months prior to graduation from IBI, TVCC provides wonderful School Sup-

port Services (the same services mentioned above for parents who opt out and choose

school over IBI) to help these children transition into real schools. To complement this

shift, TVCC also offers autistic children a special class room designed to help them tran-

sition smoothly into their school. However, there are usually only 2-3 children attending

this class at one time. Though the teacher to child ratio is great for learning, it’s not a

true representation of a real classroom therefore; this program may not be as effective

and reflective of a real classroom as it could be.

According to Vanderborght, the director of The Autism Program at TVCC, chil-

dren in their IBI program are monitored and evaluated every 2-3 months to determine

whether they are learning and progressing at a fast enough pace, according to her all

Autism Services Evaluation 9

children in TVCC’s IBI program show gains; children in IBI are supposed to learn faster

than other children because they spend 25-30 hours learning through activity embedded

teachings as opposed to other children who learn things on their own through incidental

learning. Only fast learners are kept in TVCC’s IBI program. The slow learners are

taken out of the program. The reasoning behind that is: if the child is having hard time

learning in such a fast paced environment, they might be better suited for a slower

paced learning environment like that of a school.

It seems cruel for parents and the child to wait years to get into IBI only to be re-

jected a few months into the program. TVCC boasts about tailoring their services in ac-

cordance with the needs and strengths of the individual. Yet, they don’t customize IBI

to suit the needs of slower paced learners.

Critique of the Facility

In all other aspects, TVCC seemed like a wonderful place. The atmosphere was

child friendly, the waiting rooms had toys, stuffed animals and even Nintendo’s so that

the children don’t get bored or irritated. There was also an easily accessible Resource

Centre which is often used as a waiting room, containing disability related journals,

books on parenting, education, medical references, children story books, CD’s, DVD’s,

internet, printer and software for loans; the best part is that all Resource Centre services

were free and available to anyone looking for information.

I was also very pleased with the extensive Community Coordination Services

available to help parents identify individually appropriate services available to them at

TVCC and within their own communities; and to also help these families find and access

funding resources, community resources and support groups.

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TVCC employs 500 volunteers as an integral part of their team approach to pro-

vide quality services and assist groups such as Dinosaur Club, Just for Moms, Ability

Connection, Kids on the Block, Kids on Track, Parent Mentors, New Beginnings, Parent

Connections, Self Discovery, Youth Enroute and Community Feeding Resources (see

appendix for their descriptions). TVCC works hard to help their clients attain the best

available quality of life and health through a multidisciplinary team of professionals and

volunteers.

The facility impressed me further with their state of the art equipment in their

Augmentative Communication Centre, Fitness Centre, Gait Lab, Fabrication shop and

the enormous variety of equipment available through their Assistive Devices Program.

The Arts and Crafts Therapy room on the other hand was astonishingly dull and empty

looking.

As a health care facility, many of the children at TVCC have medical conditions

that make it very dangerous for them to get infections. As a precaution I was happy to

see that there were hand sanitizing stations at every floor and everyone entering the

building was asked to sanitize their hands. Additionally, TVCC asks parents and chil-

dren to return back home if they are sick. However, upon entering the building I wasn’t

asked if I was sick, and the sanitation station was a little out of the way.

The building appeared to be child safe and assessable; TVCC seems committed

to providing a barrier-free environment. The facility even employs a special Accessibil-

ity Advisory Committee compromised of mainly persons with disabilities to help identify

and remove barriers. Recent accessibility reports show that there was a concern over

some door activation buttons being too small to push; since then, new door operators

Autism Services Evaluation 11

with larger push buttons have been installed (Accessibility Plan, 2010). The facility also

had safety barriers by every staircase to prevent accidents. Furthermore, the swimming

pool at the facility was shallow, warm, had a life guard on duty and had lifts to help dis-

abled children get in and out of the pool with ease. The only accessibility issue I noticed

was parking, not only do patients have to pay for parking but it is also located across the

road from the facility. This serves as a huge hassle for persons with disabilities espe-

cially during the snowy winter months. The staff informed us that this problem will get

better in two years when The Children’s Hospital develops adjacent to the facility. The

hospital will have indoor tunnels connecting the parking lot to the hospital and TVCC.

Overall, The Staff members at TVCC were very helpful and welcoming. All my

emails and phone calls were answered promptly. The Community Relations Coordinator

went up and above my expectations to provide me with the knowledge I needed. TVCC

proved to be a very committed and hard working facility compromised of remarkable

professionals and volunteers, providing quality care, services and barrier free access.

References

Accessibility Plan.(2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, from http://www.tvcc.on.ca/accessibility-plan.htm

Autism Intervention Program. (2010). An introduction for parents. [Brochure]. Thames Valley Children’s Centre.

Autism Intervention Program. (2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, from http://www.tvcc.on.ca/introducing-the-autism-intervention-program.htm

Beyond Disability. (2010). TVCC at a Glance. [Brochure]. Thames Valley Children’s Centre.

Chaban, P., 2005. Autism, intensive behavioural intervention (IBI), and the school. About Kids Health. Retrieved March 12, 2010, from

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http://www.aboutkidshealth.ca/News/Autism-intensive-behavioural-intervention-IBI-and-the-school.aspx?articleID=7992&categoryID=news-poh1

Deskin, B., 2005. Autism in Canada. Fact sheet. Retrieved March 13, 2010, from http://featbc.org/downloads/AutismInCanadaflyer.pdf

Enhancing capacity in autism. (2010). School Support Program. [Brochure]. Thames Valley Children’s Centre.

Groups. (2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, from http://www.tvcc.on.ca/groups-2.htm

History. (2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, from http://www.tvcc.on.ca/our-history.htm

Mission, Vision and Values. (2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, http://www.tvcc.on.ca/our-clients-at-their-best.htm

Perry, A., Cummings, A., Geier, J. D., Hughes, S., Freeman, N., LaRose, L., et al. (2006). Outcomes in the Ontario IBI program. The Ontario Association for Behav-ioral Analysis. Retrieved March 12, 2010, from http://www.ontaba.org/outcomeIBI.htm

Perry, A. (2002). Intensive early intervention program for children with autism: Back-ground and design of the Ontario preschool autism initiative. Journal on Develop-mental Disabilities,9, 121-128.

School Support Program. (2010). Thames Valley Children’s Centre. Retrieved March 15, 2010, from http://www.tvcc.on.ca/school-support-program-autism-spectrum-disorder.htm

Verspagen, T., (2010). Service Coordinator. Thames Valley Children’s Centre.

Vanderborght, V., (2010). Director of Autsim Program. Thames Valley children’s Centre.

Ziegner., K. (2010).Community Relations Coordinator. Thames Valley Children’s Centre.

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AppendixGroups at TVCC

Ability Connection  young people with disabilities are available for speaking engagements 

Dinosaur Club

 

a social group for children with a Neuromuscular Disability (such as Mus-cular Dystrophy or Spinal Muscular Atrophy) and their families

Just for Moms

 

for moms of a child with a disability

Kids on the Block

 

a troupe of life-sized puppets with and without disabilities, designed to teach children what it is like to be different

Kids on Track

 

for children with differences in learning, attention, and movement

Parent Mentors

 

parents of children with special needs

New Beginnings

 

for families who have recently learned of their families special needs

Parent Connections 

 

for parents of children with disabilities

Self Discovery

 

for youth to explore, clarify and share goals

Youth EnRoute

 

gives individuals the opportunity to explore their interests and to develop skills

Community Feeding Resource

  provide support to community therapists working with preschoolers who have feeding