The National Standards Project– Phase 2 - PowerPoint Presentation

 The National Standards Project– Phase 2
 The National Standards Project– Phase 2

The National Standards Project– Phase 2 - Description


Superheroes social skills training Rethink Autism internet intervention parent training evidencebased practices classroom training functional behavior assessment An autism spectrum disorder evidencebased practices training track for school psychologists ID: 774669 Download Presentation

Tags

national intervention standards nsp national intervention standards nsp phase project evidence 2015 based interventions autism amp training treatment behavioral

Download Section

Please download the presentation from below link :


Download Presentation - The PPT/PDF document " The National Standards Project– Phase..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.

Embed / Share - The National Standards Project– Phase 2


Presentation on theme: " The National Standards Project– Phase 2"— Presentation transcript


Slide1

The National Standards Project– Phase 2

Superheroes social skills training, Rethink Autism internet intervention, parent training, evidence-based practices classroom training, functional behavior assessment: An autism spectrum disorder, evidence-based practices training track for school psychologistsUS Office of Education Personnel Preparation Grant H325K12306William Jenson, Ph.D., Elaine Clark, Ph.D., Julia Hood Ph.D., & John Davis, Ph.D.

Diana Askings McCarty, B.S.

University of Utah School Psychology Program

February 24, 2016

Slide2

Overview

Introduction

National Autism Center & National Standards Project

Evidence-Based Practice

Methodology

Scientific Merit Rating Scale

Intervention Effects Rating Scale

Strength of Evidence Classification System

Subclassification

System

Results

NSP-Phase 1

NSP-Phase 2

Other Systematic Reviews—NPDC

Slide3

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interactions/communication and by restricted, repetitive patterns of behaviorASD occurs in approximately 1 in every 68 births (CDC, 2014)Societal costs for each individual with ASD across the lifespan is estimated at $3.2 million (Ganz, 2007)Intervention selection is complicatedA large number of interventions are available Different levels of intervention supportThe research is often confusing to parents, educators, and service providers

(National Standards Project-Phase 2, 2015)

Slide4

The National Autism Center

May Institute’s Center for the Promotion of Evidence-based Practice“…a nonprofit organization dedicated to disseminating evidence-based information about the treatment of autism spectrum disorder (ASD), promoting best practices, and offering comprehensive and reliable resources for families, practitioners, and communities.” TrainingPublic PolicyResearch

(National Standards Project-Phase 2, 2015; http://www.nationalautismcenter.org/)

Slide5

What is the National Standards Project?

The National Standards Project (NSP) is a comprehensive analysis of the interventions available for individuals with ASDStrength of evidence supporting interventionsAge, diagnosis, and skills/behaviors targetedLimitations of researchEvidence-based practice recommendationsIf you use effective intervention, the lifetime cost can be reduced by 65% (Jarbrink & Knapp, 2001)

(National Standards Project-Phase 2, 2015)

Slide6

Evidence-Based Practice (EBP)

“…the integration of the best research evidence, professional judgment, and values and preferences of clients.” (Sackett et al., 2000)EBP has become the standard in the fields of medicine, psychology, education, allied health, and ASDKey Elements of EBPProfessional JudgmentValues and PreferencesCapacityResearch Findings

(National Standards Project-Phase 2, 2015)

Slide7

Scientific Merit Rating Scale (SMRS)

Developed to objectively evaluate the strength of each study’s methodologyResearch DesignExperimental control; number of participants/groups; attrition; type of research designMeasurement of the DVAccurate and reliable data that represent the most direct/comprehensive target sampleMeasurement of the IVIntervention fidelity; implementation accuracy; percentage/type of sessions for data collectionParticipant AscertainmentWell-established diagnostic tools/procedures were used to determine participant inclusion; use of the DSM or ICD Generalization & Maintenance EffectsObjectively demonstrating intervention effects across time, settings, stimuli, responses, or personsRatings from 0 (poor)  5 (strong)

(National Standards Project-Phase 2, 2015)

Slide8

(National Standards Project-Phase 2, 2015)

Slide9

(National Standards Project-Phase 2, 2015)

Slide10

SMRS Scores

Composite scoreResearch Design (.30) + Dependent Variable (.25) + Participant Ascertainment (.20) + Procedural Integrity (.15) + Generalization (.10)Score of 3, 4, or 5 Sufficient scientific rigorScore of 2Initial evidence about intervention effects, but more rigorous research is neededScore of 0 or 1Insufficient scientific rigor/evidence to suggest whether the intervention was or was not beneficial, ineffective, or harmful

(National Standards Project-Phase 2, 2015)

Slide11

Intervention Effects Rating Scale

BeneficialSufficient evidence to support favorable outcomes resulted from the interventionIneffectiveSufficient evidence to support favorable outcomes did not result from the interventionUnknownNot enough information to confidently determine the intervention effectsAdverse (NSP-1)Sufficient evidence that the intervention was associated with harmful effects

(National Standards Project-Phase 2, 2015)

Slide12

(National Standards Project-Phase 2, 2015)

Slide13

Strength of Evidence Classification System

(National Standards Project-Phase 2, 2015)

Slide14

Strength of Evidence Classification System

(National Standards Project-Phase 2, 2015)

Slide15

Intervention Subclassification

Phase 1 was broken down into Treatment Targets, Age Groups, and Diagnostic GroupsIntervention Targets (14 targets in 2 categories)Skills IncreasedAcademic, Communication, Higher Cognitive Functions, Interpersonal, Learning Readiness, Motor Skills, Personal Responsibility, Placement, Play, Self-RegulationBehaviors DecreasedGeneral Symptoms, Problem Behaviors, Restricted/Repetitive/Nonfunctional Patterns of Behaviors/Interests/Activity (RRN), Sensory or Emotional Regulation (SER)Age Groups0-21 years22+ years

(National Standards Project-Phase 2, 2015)

Slide16

Subclassification Process

(National Standards Project-Phase 2, 2015)

Slide17

Phase 1

Released in 2009Research published between 1957 to 20077,038 abstracts initially identified775 studies after inclusion/exclusion criteria were appliedUnrelated to ASDUnrelated to the treatment of ASDNot empirical articles38 treatment categories identified by an expert panelReliability IOA .92

(National Standards Report, 2009)

Slide18

Inclusionary & Exclusionary Criteria

InclusionaryPublished in peer-reviewed journals Diagnosed with ASDAutistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder-NOSThe treatments could be implemented in school systems, early intervention, home, hospital, and/or community-based programsExclusionaryRhett’s Disorder, Childhood Disintegrative Disorder, “At Risk” for ASD, & uncommon co-morbid conditionsOnly educational and behavioral treatments that target the core characteristics of ASDNon-empirical researchPrimary purpose to identify mediating or moderating variablesOver the age of 22Non-English publications

(National Standards Report, 2009)

Slide19

Results- “Established”

11 treatments had sufficient evidence to confidently determine that the treatment produces beneficial effectsAntecedent Package (99)Behavioral Package (231)Comprehensive Behavioral Treatment for Young Children (22)Joint Attention Intervention (6)Modeling (50)Naturalistic Teaching Strategies (32)Peer Training Package (33)Pivotal Response Treatment (14)Schedules (12)Self-management (21)Story-based Intervention Package (21)

(National Standards Report, 2009)

Slide20

Results- “Emerging”

22 treatments had 1+ studies to suggest beneficial intervention effects, but additional high quality studies are needed to draw firm conclusions

Augmentative and Alternative Communication Device (14)Cognitive Behavioral Intervention Package (3)Developmental Relationship-based Treatment (7)Exercise (4)Exposure Package (4)Imitation-based Interaction (6)Initiation Training (7)Language Training—Production (13)Language Training—Production & Understanding (7)Massage/Touch Therapy (2)Multi-component Package (10)Music Therapy (6)Peer-mediated Instructional Arrangement (11)Picture Exchange Communication System (13)Reductive Package (33)Scripting (6)Sign Instruction (11)Social Communication Intervention (5)Social Skills Package (16)Structured Teaching (4)Technology-based Treatment (19)Theory of Mind Training (4)

(National Standards Report, 2009)

Slide21

Results- “Unestablished” &“Ineffective/Harmful”

5 treatments had little to no evidence to draw firm conclusions about treatment effectivenessAcademic Interventions (10)Auditory Integration Training (3)Facilitated Communication (5)Gluten- and Casein-Free Diet (2)Sensory Integrative Package (7)0 identified studies indicated sufficient evidence that a treatment is ineffective or harmfulEthical reasonsNot published

(National Standards Report, 2009)

Slide22

Limitations & Discussion

Since Phase 1, the DSM criteria for ASD has changedDid not include individuals with ASD 22+ years old“At risk” or comorbid not includedTreatment categoriesOnly quantitative studies All articles were in EnglishDid not evaluate “real world” vs. laboratory settingsTreatment intensity not evaluatedLiterature review ended in September 2007

(National Standards Report, 2009)

Slide23

Phase 2

Released April 2, 2015To provide updated information on intervention effectivenessReviewed studies between 2007 and February 2012Included studies with adults 22+ years oldReviewed studies since 198727 articles identifiedCategory Revision“Established” interventions are presented in more detail

(National Standards Project-Phase 2, 2015)

Slide24

Phase 2—Goals

Primary goalsIdentify peer-reviewed intervention outcome studies for individuals with ASD since the publication of NSP-1Review interventions for individuals across the lifespanIncorporate feedback received regarding NSP-1 categorizationTo help parents, caregivers, educators and service providers understand how to integrate evidence-based interventions into a well-rounded, individualized educational/behavioral program

(National Standards Project-Phase 2, 2015)

Slide25

(National Standards Project-Phase 2, 2015)

Slide26

Expert Panel

Hanna C. Rue, Ph.D., BCBA-D (Chair)Grace Baranek, Ph.D., OTR/LJane I. Carlson, Ph.D., BCBA-DAlice Carter Ph.D.Marjorie H. Charlop, Ph.D., BCBARonnie Detrich, Ph.D.Melanie DuBard, Ph.D., BCBA-DGlen Dunlap, Ph.D.Peter Gerhardt, Ed.D.Lynne Gregory, Ph.D.Robert H. Horner, Ph.D.Kara Anne Hume, Ph.D.James K. Luiselli, Ed.D., ABPP, BCBA-DDaniel Martin, Ph.D., BCBA

Gail McGee, Ph.D.Samuel L. Odom, Ph.D.Cathy L. Pratt, Ph.D.Patricia A. Prelock, Ph.D., CCC-SLPRobert F. Putnam, Ph.D., BCBA-DSally J. Rogers, Ph.D.Carol M. Schall, Ph.D.Ilene S. Schwartz, Ph.D., BCBA-DMark D. Shriver, Ph.D.Tristram H. Smith, Ph.D.Brenda Smith Myles, Ph.D.Aubyn C. Stahmer, Ph.D., BCBA-DPamela J. Wolfberg, Ph.D.John G. Youngbauer, Ph.D.

(National Standards Project-Phase 2, 2015)

Slide27

(National Standards Project-Phase 2, 2015)

Slide28

Inclusionary & Exclusionary Criteria

InclusionaryPublished in peer-reviewed journals Diagnosed with ASDAutistic Disorder, Asperger’s Syndrome, and Pervasive Developmental Disorder-NOSThe interventions could be implemented in school systems, early intervention, home, hospital, vocational and/or community-based programs or clinic settingsExclusionary“autistic characteristics” or “suspicion of ASD”, & uncommon co-morbid conditions (except for individuals 22+)Only educational and behavioral treatments that target the core characteristics of ASDNon-empirical researchPrimary purpose to identify mediating or moderating variablesNon-English publications

(National Standards Project-Phase 2, 2015)

Slide29

Presentation

(National Standards Project-Phase 2, 2015)

Slide30

Results- “Established”Under 22 years old

14 interventions had sufficient evidence to confidently determine that the intervention produces beneficial effects (**: NSP-1 “emerging”; underlined: Different from NSP-1)

Behavioral Interventions (NSP-1=298 NSP-2=155)Cognitive Behavioral Intervention Package ** (NSP-1=3 NSP-2=10)Comprehensive Behavioral Treatment for Young Children (NSP-1=21 NSP-2=20)Language Training—Production ** (NSP-1=10 NSP-2=2)Modeling (NSP-1=51 NSP-2=28)Natural Teaching Strategies (NSP-1=27 NSP-2=3)Parent Training (NSP-1=37* NSP-2=11)Peer Training Package (NSP-1=43 NSP-2=3)Pivotal Response Treatment ® (NSP-1=11 NSP-2=6)Schedules (NSP-1=11 NSP-2=2)Scripting ** (NSP-1=6 NSP-2=5)Self-management (NSP-1=21 NSP-2=10)Social Skills Package ** (NSP-1=14 NSP-2=21)Story-based Intervention (NSP-1=21 NSP-2=15)

(National Standards Project-Phase 2, 2015)

Slide31

Results- “Emerging”Under 22 years old

18 interventions had 1+ studies to suggest beneficial intervention effects, but additional high quality studies are needed to draw firm conclusions

Augmentative and Alternative Communication DevicesDevelopmental Relationship-based TreatmentExerciseExposure PackageFunctional Communication TrainingImitation-based InteractionInitiation TrainingLanguage Training—Production & UnderstandingMassage TherapyMulti-component PackageMusic TherapyPicture Exchange Communication SystemReductive PackageSign InstructionSocial Communication InterventionStructured TeachingTechnology-based Intervention Theory of Mind Training

(National Standards Project-Phase 2, 2015)

Slide32

Results- “Unestablished”Under 22 years old

Animal-assisted TherapyAuditory Integration TrainingConcept MappingDIR/Floor Time **Facilitated CommunicationGluten-free/Casein-free DietMovement-based InterventionSENSE Theatre InterventionSensory Intervention PackageShock TherapySocial Behavioral Learning StrategySocial Cognition InterventionSocial Thinking Intervention

13 interventions had little to no evidence to draw firm conclusions about intervention effectiveness

(National Standards Project-Phase 2, 2015)

Slide33

Results- 22+ years old

Earliest study published in 19871 “established” interventionBehavioral Interventions (17)1 “emerging” interventionVocational Training Package4 “unestablished” interventionsCognitive Behavioral Intervention PackageModelingMusic TherapySensory Integration PackageMore research is needed

(National Standards Project-Phase 2, 2015)

Slide34

Intervention Selection

A team of individuals should consider the unique needs of the individual as well as the environment that they live in (e.g., family situation, community, cultural and ethnic background)Consider implementing “established” interventionsDo not begin with “emerging” interventions but consider them if an “established” intervention is inappropriate or unsuccessful at producing positive outcomes.Only consider “unestablished” interventions if additional research produces supportive results

(National Standards Project-Phase 2, 2015)

Slide35

Limitations & Future Directions

Only published, peer-reviewed research through January 2012Lack of information on race/ethnicity, gender, or SES Intervention categoriesRemember–even “established” interventions will not be effective for all individuals with ASDMore research is needed to identify variables that predict who will likely respond to interventionInterventions for “high-risk siblings” Level of functioning, intervention intensity, & social validity Qualitative studiesNon-English studiesImpact of cultural diversity

(National Standards Project-Phase 2, 2015)

Slide36

Other Systematic Reviews

Centers for Medicare and Medicaid Services (CMS)http://www.impaqint.com/work/project-reports/autism-spectrum-disorders-services-asds-final-report-environmental-scan Agency for Healthcare Research and Quality (AHRQ)http://www.effectivehealthcare.ahrq.gov/ehc/products/544/1974/autism-update-140923.pdf The National Professional Development Center on Autism Spectrum Disorder (NPDC)http://autismpdc.fpg.unc.edu/evidence-based-practices

(National Standards Project-Phase 2, 2015)

Slide37

Evidence-Based Practices for Children, Youth, and Young Adults with ASDThe goal of the NPDC was to promote the use of evidence-based practices (EBPs) for children and youth with ASD, birth to 22 years of ageComprehensive Treatment Models vs Focused Intervention PracticesTEACCH, ESDM, UCLA Young Autism ProgramDTT, Pivotal Response Training, Prompting, Video Modeling1st review released in 2010 (1997-2007)24 interventions identified as EBP Very similar results to NSP-1 Current review 2014 (1990-2011)

(Wong et al., 2014)

Slide38

Methodology

National set of external reviewers (N=159)InclusionIndividuals with ASD under 22 years oldCo-morbid conditionsBehavioral, developmental, or educational interventions and outcomes implemented at home, school, or the communityCompared to no intervention or alternative interventionExperimental group, quasi-experimental group, or single-case designLiterature search29,106 articles (ASD/Interventions)  456 articlesArticles categorizedEBP determined

(Wong et al., 2014)

Slide39

Evidence-Based Practice Criteria

Slide40

Results

27 interventions identified as evidence-based practices

(Wong et al., 2014)

Antecedent-based Intervention

(0;32)

Cognitive Behavioral Intervention

(3;1)

Differential Reinforcement of Alternative, Incompatible, or Other Behavior

(0;26)

Discrete Trial Teaching

(0;13)

Exercise

** (3;3)

Extinction

(0;11)

Functional Behavior Assessment

(0;10)

Functional Communication Training **

(0;12)

Modeling

(1;4)

Naturalistic Intervention

(0;10)

Parent-implemented Intervention

(8;12)

Peer-mediated Instruction and Intervention

(0;15)

Picture Exchange Communication System **

(2;4)

Pivotal Response Training

(1;7)

Prompting

(1;32)

Reinforcement

(0;43)

Response Interruption/Redirection

(0;10)

Scripting

(1;8)

Self-management

(0;10)

Social Narratives

(0;17)

Social Skills Training

(7;8)

Structured Play Group

(2;2)

Task Analysis

(0;8)

Technology-aided Instruction and Intervention **

(9;11)

Time Delay

(0;12)

Video Modeling

(1;31)

Visual Supports

(0;18)

Slide41

Discussion

24 interventions identified were not classified as EBP, but had some support; more research is neededFoundational applied behavior analysis techniques have the most support Idiosyncratic Behavioral Intervention PackageMany similarities to NSPDeveloping online modules (AFIRM) for each of the 27 identified practicesCurrently modules are available for 24 practices previously identified

(Wong et al., 2014)

Slide42

References

Centers for Disease Control and Prevention. (March 28, 2014).

Morbidity and mortality weekly report

. Retrieved February 16, 2016, from

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6302a1.htm?s_cid=ss6302a1_w

.

Ganz

, M. L. (2007). The lifetime distribution of the incremental societal costs of autism.

Archives of Pediatrics Adolescent Medicine

, 161(4), 343-349.

Jarbrink

, K. and Knapp, M. (2001). The economic impact of autism in Britain.

Autism: the international journal of research and practice

, 5(1), 7-22.

doi

: 10.1177/1362361301005001002

National Autism Center. (2009).

National standards report

. Retrieved January 31, 2016, from

http://www.nationalautismcenter.org/

.

National Autism Center. (2015).

Findings and conclusions: National standards project, Phase 2

. Retrieved January 31, 2016, from

http://www.nationalautismcenter.org/

.

Odom, S. L., Collet-

Klingenberg

, L., Rogers, S. J., & Hatton, D. D. (2010). Evidence-based practices in interventions for children and youth with autism spectrum disorders.

Preventing School Failure

, 54(4), 275-282.

Sackett

, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence-based medicine: How to practice and teach EBM. London, UK: BMJ Books.

Warren, Z.,

Veenstra-VanderWeele

, J., Stone, W.,

Bruzek

, J. L.,

Nahmias

, A. S., Foss-

Feig

, J. H., &

McPheeters

, M. (2011). Therapies for children with autism spectrum disorders. Comparative effectiveness review, Number 26. AHRQ publication No.11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality.

Wong, C., Odom, S. L., Hume, K., Cox, A. W.,

Fettig

, A.,

Kucharczyk

, S., Brock, M. E.,

Plavnick

, J. B.,

Fleury

, V. P., Schultz, T. R. (2014). Evidence-based practices for children, youth, and young adults with autism spectrum disorder. Journal of Autism and Developmental Disorders.

doi

: 10.1007/s10803-014-2351-z.

Young, J.,

Corea

, C.,

Kimani

, J., &

Mandell

, D. (2010). Autism spectrum disorders (ASDs) services: Final report on environmental scan (pp. 1-59). Columbia, MD: IMPAQ International.

Slide43

Thank you!

NSP-1:

http://www.nationalautismcenter.org/reports/

NSP-2:

http://www.nationalautismcenter.org/national-standards-project/results-reports/

Shom More....