What is EIIS?
EIIS Video
EIIS Service Delivery System
What is ASD?
Service Provider
Parent Resource Package
Training Opportunities
Regional Evaluation Report
Executive Summary Early Identification and Intervention Services (EIIS) is an intersectoral initiative of the Western Regional Child and Youth Action Committee (WRCAYAC) that aims to enhance services in health, education and community service sectors for children with Autistic Spectrum Disorders (ASD) aged birth to six years and their families. The EIIS initiative in Western Nova Scotia is funded by the Province's Child and Youth Action Committee (CAYAC) and receives considerable in-kind contributions from partnering organizations to carry out project activities.
In October 2000, the Child and Youth Intersectoral Working Group (CYIWG) of the Western Regional Child and Youth Action Committee (WRCAYAC) brought together regional stakeholders to develop the Region's funding proposal to enhance services for children with ASD. By May 2001, the EIIS Sub-committee of the Nova Scotia Child and Youth Action Committee (CAYAC) formally approved the EIIS Regional Grant Application for Western Nova Scotia. The EIIS Implementation Team was then formed as a advisory committee to coordinate project activities under the direction of CYIWG.
By March 2002, the EIIS project established two Diagnostic Assessment Sites (DAS) and three EIIS Autism Teams to provide services to children with ASD and their families across the Region's seven counties; Lunenburg, Queens, Shelburne, Yarmouth, Digby, Annapolis, and Kings. Service providers of partnering agencies from community services, education and health sectors work collaboratively, as part of the EIIS Autism Teams, to provide coordinated multi-disciplinary assessments and interventions that aim to impact positively on the long-term functional outcomes of children with ASD.
In May 2002, the EIIS Implementation Team's Evaluation Working Group distributed surveys to four target groups (physicians, service provides, schools, and families with children with ASD) to begin the first of two phases in their evaluation plan. A subsequent survey of the target groups was conducted in September 2003. The purpose of the evaluation process was to collect data at two points along project implementation in order to make comparisons of how service delivery changed over time and to determine what impacts the EIIS Autism Teams and other service enhancements have had on the communities they serve.
Summary of Findings: Physicians
Physicians were asked about the screening, assessment and interventions they provide specific to Autistic Spectrum Disorders (ASD). They were also asked to rate their level of comfort in applying their knowledge and to indicate their familiarity with local services for children with ASD.
Overall, physicians reported little change in the screening, diagnostic and intervention services they provide specific to ASD despite the Region's efforts to involve them in the identification process. No physicians reported screening for ASD. Meanwhile, twice as many physicians in 2003 indicated that they would refer children to a pediatrician for assessment should a suspicion of ASD exist. Although a physician referral is not required to access EIIS services, parents often express concerns about their child's development to family practitioners. For many families, contact with a family physician may be the only opportunity for a professional to assess the signs of developmental delay prior to school entry. It is suspected that many children with ASD could be detected earlier if physicians were better equipped to recognize the signs and symptoms of ASD.
Referrals to a pediatrician for assessment is a positive step forward to assisting families in accessing services and ensuring that interventions take place as early as possible. However, many physicians and pediatricians continue to report that they would refer families to services outside the Region. This practice has resulted in increased delays for families as referrals are redirected to local service delivery teams.
Recommendation #1: EIIS Autism Teams continue to develop awareness initiatives for physicians of local services available for families with children with ASD to ensure that appropriate referral routes are followed and delays are minimized.
Training and knowledge levels of physicians specific to ASD did not change substantially from 2002 to 2003. The results suggest that many physicians do not have the information required to adequately identify children along the autistic spectrum and to make timely referrals to a pediatrician or autism team for diagnosis. For many families, contact with a family physician may be the only opportunity for a professional to assess the signs of developmental delay prior to school entry.
Recommendation #2: The Region work in collaboration with any provincial initiatives to make continuing medical education available to physicians and help them to recognize the red flags associated with developmental delay, including autism.
Physicians cannot be expected to understand all aspects of possible interventions but should be familiar with community resources that can help families with children with ASD in the areas of behaviour, social understanding and communication. Physicians report the most familiarity with in-hospital services and the least familiarity with community-based services. In Phase II, physicians familiar with local services report making more referrals than in Phase I.
Recommendation #3: The Region develop a strategy to build partnerships with physicians and raise awareness of the local services available to support families with children with ASD.
Summary of Findings: Schools
Few schools responded to the evaluation survey in Phase I, making it difficult to draw any meaningful comparisons from one year to the next. However, data obtained in Phase II indicates that EIIS has had a positive impact on service delivery within the school system: most significantly, improving collaboration with community organizations serving children with ASD prior to school entry.
With the implementation of the EIIS initiative, it was hoped that the number of children with ASD identified after school entry would decrease. Preliminary observation may be indicative of an early trend in which the percentage of children with ASD identified after school entry is declining as a result of the EIIS initiative. However, at the onset of implementation, referrals for diagnostic assessment increased across the Region as awareness and services improved. This increase in identification and referral also applies to school-age children and, as a result, in may take several years before efforts towards early diagnosis result in significantly fewer children with ASD beginning school without having been diagnosed prior to entry.
Recommendation #4: Ongoing professional and parent awareness of ASD is required to promote early identification in pre-school children.
For children receiving intervention services prior to school entry, schools reported that they were more satisfied with the transition planning process in Phase II than in Phase I. They reported greater lead times and longer transition periods that involved more partnering agencies and supports. More schools reported that the available supports were helpful and knowledgeable. They felt that support services were aware of the child's needs and could be accessed for program planning. These changes correspond to the implementation of the EIIS initiative and suggest that EIIS has had a positive impact on removing some of the barriers identified by schools, thereby, improving school satisfaction with the transition planning process.
Recommendation #5: Pre-school service providers must continue to be available to schools for child-specific support during transition planning and for problem solving during the first year of school to ensure as smooth and as successful a transition as possible.
In addition, a higher percentage of teachers and support personnel, from schools with children with ASD enrolled in their system, reported receiving training specific to ASD in Phase II compared to Phase I. Increased training opportunities, focusing on ASD, made available by EIIS, school boards and events delivered in partnership have had a positive impact on building staff knowledge and skills specific to ASD.
Recommendation #6: On-going training is required to support professional development and increase staff comfort levels in applying their knowledge of intervention strategies within a classroom setting.
Summary of Findings: Families
Families across the Western Region were asked to identify and rate the quality of pre-school services they received in regards to their child's Autistic Spectrum Disorder. Families participating in an Individual Family Service Planning (IFSP) process were also asked to rate how well it met their needs.
Data obtained from parents suggests that children with ASD in the Western Region are diagnosed at an earlier age and with less wait from the time parents first have concerns about their child's development. Families also indicate that they are accessing services from their local EIIS Autism Teams rather than from services outside the Region (e.g., IWK). On-going public awareness of developmental delay and the importance of early identification is required to ensure that families know when and how to access services.
Recommendation #7: On-going public awareness of developmental delay, including parent and professional education of developmental "red flags," is required to ensure children are identified as early as possible.
Overall, at both intervals, families found the pre-school services available to them to be very helpful in meeting their needs. Families reported being pleased with pre-school services once gaining access to them. The most frequent frustration expressed by parents in phase I was a lack of access to services. On average, families reported accessing more services in Phase II than in Phase I.
Families also report that they are pleased with the quality of the pre-school services they receive. Families' ratings of quality factors remained consistent from one year to the next, suggesting that once families receive services they are pleased with them. The most significant change reported by families was in the availability of services. In Phase II, families felt that a greater range of services was available to them within a reasonable distance from their home.
The data obtained suggests that the EIIS initiative may have precipitated improvements in quality factors that impact on providing family-centered services such as, advocacy, flexibility, follow-though, and empowerment. However, ratings on family focus decreased and suggest that additional attention is required to ensure that services focus on the whole family rather than just the child. Training in family-centered practice and IFSP planning should help service providers better meet the needs of the family as a whole. This training was delayed until October 2003, subsequent to the distribution of both evaluation questionnaires.
Families are also generally satisfied with the IFSP process, particularly as it relates to meeting the needs of their children. As indicated, more work is required to ensure that families have an opportunity to discuss their needs and to ensure that a family's situation is taken into consideration when setting and revising IFSP goals.
Recommendation #8: On-going professional development be made available to support service providers in meeting the needs of families using a strengths-based, family-centered approach.
Financial costs, travel (distance for appointments), and childcare continue to be the barriers most reported by families that prevent them from accessing services. Bringing services as close as possible to local communities helps to minimize these barriers.
The main topics of family comments shifted focus from Phase I to Phase II. Family comments in Phase I focused mainly on service delivery topics including time for intervention, early detection, service provider training, follow-through, and staff time constraints. Comparatively in Phase II, many more families commented on bringing families together, expanding peer support networks and developing playgroups for children with ASD. Comments around service delivery focused mainly on building understanding across agencies and providing additional services following school entry.
Recommendation #9: EIIS provide on-going support in developing and maintaining support networks to ensure that families stay connected.
Over the course of the EIIS initiative, training subsidies have been allotted to families, improving access to workshops and conferences in support of the families' roles in providing interventions for their children. Without assistance, financial costs, travel, and childcare barriers will prevent many rural families from accessing training opportunities.
Recommendation #10: A regional training plan for families be developed to support their role in intervention services and their participation in training opportunities, including dedicated resources for this purpose.
Summary of Findings: Service Providers
Service providers from the community and health sectors across the Western Region were asked to describe the services they provide for children with ASD, identify the impacts EIIS has had on their organization's capacity to deliver services and complete a skills inventory to determine staff training in ASD-specific topics.
Most agencies and organizations across the Western Region indicate that children with ASD and their families qualify for their services. Service providers identify a child's age as the criterion most frequently used to determine eligibility for service.
Although the EIIS initiative did not intend to have an impact on eligibility criteria across the service delivery sectors, the information collected provides a description of existing eligibility criteria and identifies service delivery gaps which may be addressed in future program planning: in particular, the lack of support services available after school entry for children with ASD. An increase, from Phase I, in the percentage of some services reporting that school-aged children with ASD are eligible for programming was observed in Phase II. This suggests that community-based training efforts and EIIS support in building the Region's overall capacity to deliver services has had a positive impact beyond the pre-school years.
Recommendation #11: Identify support services required after school entry and work collaboratively to explore service delivery options for improving access to ASD services across the life span.
The EIIS initiative has positively impacted on the Region's capacity to deliver services. Families are able to access diagnostic assessment services from one of the Region's two Diagnostic Assessment Sites with reduced waiting times. The EIIS initiative has also improved access to clinicians for local intervention services now available from one of three EIIS Autism Teams. For organizations where EIIS staff enhancements were implemented, waiting times for diagnostic and intervention services specific to ASD have been substantially reduced.
The percentage of service providers who report referring families to two or more services for diagnostic assessment decreased in 2003, suggesting that they are now familiar with the EIIS referral process. A clearly established open referral process available from one referral route provides efficient access to the EIIS multi-disciplinary service, reducing the number of referrals and follow-ups required. Service providers are no longer making referrals to all available programs separately in an attempt to access ASD-related services for families. In this way, the single EIIS referral route has improved referral efficiency and reduced confusion for referring agencies and/or families seeking services. In addition, the number of service providers reporting that they refer children to outside agencies decreased in 2003. Data obtained from district teams suggests that referrals to EIIS are beginning to taper off and additional efforts are needed to ensure children are identified and referred for service as early as possible on an ongoing basis.
Recommendation #12: Opportunities for population-based screening for developmental delay (including ASD) be explored by the Region to ensure that children are identified as early as possible and that timely interventions are implemented, providing the most opportunity for developmental progress.
Data obtained in Phase II of the evaluation suggests that service providers in the health and community service sectors are focusing more on providing family-centered services in which both the child's needs and the needs of the larger family are considered. In addition, the percentage of service providers reporting that their organization has a structured Individualized Family Service Planning (IFSP) process, by which service delivery goals are identified and recorded, doubled in 2003. As more organizations participate in the planning process they are afforded more opportunity to share their expertise and knowledge with each other, work collaboratively towards common goals, and reduce the redundancy of information and services. In 2003, more service providers reported that they routinely collaborate with outside agencies to develop coordinated service delivery plans than in 2002.
Recommendation #13: Ongoing professional development be made available to support service providers in meeting the needs of families using a strengths-based, family-centered approach.
A positive change in service provider participation in transition planning provides additional evidence of the positive effects of coordinating multi-disciplinary teams to implement services. The data collected indicates that Transition Teams are expanding to include service providers from a variety of organizations and agencies (e.g., daycares, family resource centers, respite services, NSHSC, mental health) who work with children with ASD prior to entry into school and daycare. Planning, preparation and implementation of transition plans within and between programs, as well as with families, should help to minimize disruptions, improve continuity of service, build trust in the EIIS service system, and increase confidence in determining the appropriate type and frequency of programming options.
In 2003, more service providers reported that they consider themselves an integral part of the Transition Planning Team rather than participating only sometimes in transition planning meetings upon request of a school. This is evidence that inter-disciplinary relationships are strengthening. Similarly for transition planning to daycare, service providers reported more frequently in 2003 that they are participating in program planning meetings when requested by the daycare.
Recommendations #14: EIIS Autism Teams work in partnership with school boards and daycares to continue to develop the transition planning process and facilitate the early integration of transition planning teams across the Region.
Although the overall percentage of service providers who reported that they routinely provide intervention services in families' homes remained the same over the course of the evaluation, the number of service providers from Mental Health Services, Rehabilitation Services and Nova Scotia Hearing and Speech Centers who sometimes or routinely conduct home visits increased. For some organizations, only their EIIS enhanced staff has the capacity to deliver home-based intervention services for families given the added resources required to make it possible (e.g., staff time, associated travel costs, insurance). Regarding diagnostic assessment, EIIS Autism Teams are providing services in two clinics across the Region. Diagnostic assessment services are not available at home or in the community at this time. More support is required to ensure that home-based intervention and assessment services can be offered as a service delivery option to all children and families.
Recommendation #15: Organizations serving children and families should identify the supports required and explore means to increase the availability of home-based services across disciplines for both assessment and intervention services.
The EIIS initiative provided the means to purchase many additional materials and resources and more service providers in 2003, than in 2002, reported having access to information and resources specific to ASD within their organizations. Many organizations maintain a lending library accessible to families, however, most do not catalogue their inventory and it is difficult for families to find what they are looking for.
Recommendation #16: ASD materials and resources across partnering organizations be catalogued to facilitate the sharing of resources.
Through both provincial and regional training initiatives many service providers gained access to additional training opportunities. Strategies to share information and provide training to community partners once service providers returned from specialized training were also employed to expand the knowledge base of those working with children with ASD in the Region. As a result, an increase in the percentage of service providers trained in areas specific to ASD was reported and the community's capacity to deliver services was enhanced. Service providers most frequently identified additional training in Applied Behavioural Analysis (ABA) / Intensive Behavioural Interventions (IBI) as an area of knowledge that requires further development.
Recommendation #18: A regional training plan be developed to support the on-going training needs of EIIS enhanced clinicians, non-EIIS clinicians, and service providers in partnering agencies that make up the Region's EIIS Autism Teams.
Service providers from various organizations and agencies report that EIIS has had a positive impact on their ability to deliver services for children with ASD and their families. The implementation of the EIIS initiative financially enhanced services for less than 20% of those who responded to the evaluation surveys, however, more than 80% of service providers from the health and community service sectors across the Western Region indicate that the EIIS initiative has had a positive impact on their ability to deliver services. In addition, more than 80% of organizations report improvements in service coordination, team approach and program planning as a result of the EIIS initiative.
Reported negative impacts, as a result of the EIIS initiative, were associated with creating a two-tiered system whereby children with ASD received additional and timelier services than other children with special needs. Initially, the EIIS project focused on children with ASD in order to develop and implement a coordinated multi-disciplinary team approach as a model for service delivery for all children with special needs. The future of expanding this model to all children with special needs should be explored.
Recommendation #17: Strengths-based, multi-disciplinary team approach to service delivery be applied as a model of service delivery for all children with special needs.
Conclusions:
Data obtained from the four target groups over the course of the evaluation process show that the EIIS initiative in the Western Region has had a positive impact on the communities' capacity to meet the needs of children with ASD and their families.
Service providers report that services are better coordinated as a result of the EIIS initiative. They report routinely collaborating with outside agencies more frequently and report participating more often in transition planning. Service providers report that follow-up to program planning is better now than before EIIS was implemented. Twice as many organizations have a structured IFSP process to identify, record and continually evaluate service delivery goals with families.
EIIS has also improved access to materials and resources, information, networking and training specific to ASD. Schools are also more satisfied with the transition planning process and have more lead time for preparation and greater access to pre-school support staff than before. Twice as many physicians say they would refer a child to a pediatrician should there be a suspicion of ASD. Families report a high satisfaction with the services they received, reduced waiting times and a greater range of available services within a reasonable distance from their homes.
On-going efforts from the health, education and community service sectors are required to support and maintain the collaboration facilitated by the EIIS initiative and to build upon the Region's achievements. A commitment of financial and other resources will be required to support enhanced staff positions and family-centered service delivery. A regional training plan will be required to ensure that staff competencies are maintained and that members of the EIIS Autism Teams have the skills required to provide on-going services. Families will also require on-going training to support their role in intervention. Continued public awareness for physicians, families and professionals on ASD and the available services to support families is essential to ensuring that families have access to services in a timely manner. Population-based screening for developmental delay would assist communities in building awareness, identifying children early and implementing interventions that afford the most opportunity for developmental progress.
For more information regarding the implementation of the EIIS initiative in Western Nova Scotia, or to obtain copies of the complete evaluation report, please contact the EIIS Regional Coordinator.
Early Identification and Intervention Services
Denise Vacon - EIIS Regional Coordinator
46 Parade Street, Yarmouth, NS B5A 3A9
Phone: (902) 749-5667 Fax: (902) 749-5697
Email: dvacon@swrsb.ednet.ns.ca
Website: http://eiiswest.nsnet.org
Christina Schulze-Allen - EIIS Regional Coordinator
Western Regional CAYAC, P.O. Box 520, Middleton
Nova Scotia, B0S 1P0
Email: csa.cyiwg@ns.sympatico.caPhone: (902) 825-5377
Fax: (902) 825-5379
Supported by
Kings Regional Rehabilitation Centre
Technical Resource Centre