Saturday, March 24, 2012

Process or Product: Fidelity of Intervention or Outcomes

The age old argument between process and product rears it’s head again when it comes to autism treatment. Too often we pay too close attention to process (treatment or intervention). Unfortunately research has shown how difficult treatment fidelity is, even in the best of conditions; but, especially when it is not the primary motivating factor of the service provider. This is not to discredit the importance of process and treatment fidelity using the correctly prescribed evidence based intervention for the child; however, outcomes, too often, receive too little attention. The outcomes I’m talking about are not the subjective feel good statements that we must be doing good or that s/he is doing better; but outcomes as demonstrated by objective, standardized, norm referenced assessments with both high validity and reliability.
Too much data “fluff” is presented as solid reason to spend money or do something. We can do better than this. Many children can make remarkable progress if the right intervention is provided by well qualified therapists in partnership with parents and providers. We do a disservice to children and families when we don’t measure and tell the truth about outcomes or in this case, real positive results and changes which benefit the child and family.

Low cost, quality, evidence based, treatment for autism

Low cost, quality, evidence based, treatment for autism is possible. Treatment for autism is now prescriptive based upon age, functioning level, and other characteristics of the child. Unfortunately billions of Medicaid, insurance, government, and personal dollars are wasted on largely ineffectual interventions. Often this is caused by poorly trained interventionists which are sometimes motivated more by money than positive outcomes for children. There is a solution, based on evidence based interventions, with well trained providers using absolute treatment fidelity and significant involvement from parents and care providers.

Thursday, March 24, 2011

The “key” to autism treatment

Years ago my wife and I owned a Ford Escort. We really liked this practical car for our young family. Unfortunately the electrical system started to short out. Fortunately it was still under warrantee. We took it in over and over again and it continued to short out. Finally someone discovered that we left a spare set of keys in the ash tray. As the car would move and the keys would jostle, a connection would be made and the car would short out. Once the keys were removed, the problem was over.
A fairly recent study by J. Smith et al demonstrated that , when closely observed, a majority of providers missed a key element of the intervention. Unfortunately this can only be assessed by either close observation over a period of time {more than can practically be accomplished} by someone who thoroughly understands the intervention, or by looking for outcomes. We need to look more to objective outcomes to assure the right intervention was provided to the child and that the key elements were included.

The financial crisis and autism intervention

The world is in a financial crisis. It will become more difficult to justify expensive autism intervention in the face of limited financial resources and competing demands. There are options. Options of much less expensive but still evidence based interventions that produce results, real measurable outcomes for children.