Wisconsin Public Television University Place Autism: A Day With The Experts  Linda Tuchman-Ginsberg Teaching Children and Youth with Autism  January 28, 2012 UP677    cc >> I know it will just take a moment for people to get settled. Hi. My name is Linda Tuchman-Ginsberg, and I'm delighted to be here this afternoon to talk about teaching children and youth with autism spectrum disorders, focusing on what works. My background is in professional development and training and technical systems and the translation of research to practice. So I've had the wonderful opportunity over the last five years to be the principal investigator or co-principal investigator for Wisconsin's involvement in a national professional development center on autism spectrum disorders. And today I'm going to spend a little bit of time giving you some background on the center, talking about what we have learned through our search of the research about what the research tells us are evidence-based practices, but then to focus on the process of how we have focused on developing materials and providing training and technical assistance and professional development to school districts and early childhood programs to actually translate those practices that the research tells us have an evidence base into their daily routines and activities in programs and talk about some of those practices that have helped us make that happen, and then look at some of the evaluation to show the impact of that work and end by sharing a little bit about some of the lessons we've learned about being effective in this work. So, the National Professional Development Center on Autism Spectrum Disorders, as Marsha mentioned in the introduction, is a three-university site project between the FPG Child Development Institute at the University of North Carolina in Chapel Hill with Sam Odom, a widely published researcher in the field of autism, in addition to the Mind Institute at the University of California Davis through their medical school with Sally Rogers and Sally Ozonoff, also well-known in the field of autism as the co-investigators for that site, and then our Waisman Center partnership. This project has been funded by the US Department of Education Office of Special Education Programs. It was part of their effort to say from the Department of Education we know we need to be paying attention to what's happening for children and youth with autism in our early intervention, early childhood and K-12 systems. So this is a list of our staff and partners, and I would just like to point out and recognize our two staff members from Waisman Center who've done the lion's share of the work in directly supporting schools and implementing evidence-based practices and that's Ellen Franzone and Kate Szidon and formally Lana Collet-Klingenberg who's now at UW Whitewater but had a significant impact on the early development of this project. 

The goals of the national center have been to promote development, learning and achievement of children and youth with autism spectrum disorders and to support their families, as I mentioned before, through the use of evidence-based practices. Secondarily, we looked at the practices that would help improve the capacity of states to implement evidence-based practices and increase the number of educational staff who are highly qualified to serve children with autism spectrum disorders. All of the work of this project has been done in partnership with states. Let's see, I'm not really used to using this thing. That's Sam Odom, who's the director of the project. I just wanted to make sure I pointed that out. These are the states that we have worked with. Over a five-year period we have worked with three sites, three states at a time for four years, wrapping up our last year of work with our 12th state. So through Wisconsin we have supported Wisconsin in the first year, Texas in the second year, and Vermont this year. So it's been so interesting to know, be grounded in our Midwest Wisconsin, move down to Texas, big state, and then have the opportunity to work in Vermont, tiny state. 

So we've had really great opportunities and experiences, but the bottom line for me is children, schools and families, there are more similarities than differences in the broad range of needs for children in our school district. Our first task was to identify the research that supports the evidence-based practices, and we really, for this project, focused on what we called focused interventions or individual practices, not a comprehensive program like might be provided in an intensive non-school-based program, but actually what are some of those individual practices that would be practical for a team of educators to be able to implement within the curriculum of a school day that helped learners with autism actually become engaged in learning and then be able to focus on participating in the curriculum and sort of general education activities to the extent possible. So we looked at research that produced specific behavioral and developmental outcomes for children that had been demonstrated as effective in applied research and can be successfully implemented in educational settings where there's so many variables for so many children in play at once. So we combed through the literature using some key words, looked through the core features of autism, looked at both group interventions that addressed the areas of autism specifically, and then set our own criteria. And one of the things that I have learned out in the field is there's this big emphasis on intervention programs, schools, early intervention, intensive programs, those funded by the waiver, by insurance, having a focus on evidence-based practices, but there also probably as many definitions of evidence-based practices as there are initiatives saying we need to use evidence-based practices. So one of our early activities was to establish the criteria for this project, and you can see from this slide that we looked at both experimental or quasi experimental design studies and single subject design. There's a lot more research and literature on single subject design than there are with experimental designs, and we thought we would be missing some really important information if we didn't include both. However, we were very focused on the importance of looking at at least five different single subject studies by three different researchers before we would include the research as supporting our evidence base, and then we looked at the combination. So we combed through the literature, and, to date, we do have a new literature review under search to see if there are new practices to add. Last year or years ago we completed a second research to make sure that all these practices still had the research to support them, to continue to be on our list. 

So this list is in alphabetical order, arranged by academics and cognition, behavior, communication, play, social and transition, meaning transitions between programs, and we looked at what was available in early childhood, elementary, middle and high school. So you can see that the practices are spread out across the age span and the different domains. What I would like to say about this list, you will notice that there are a number of behavioral interventions that are just core to engaging children with autism in social skills, communication, being available to be ready for learning such and engaging in learning, but there are also quite a few that look at more naturalistic interventions. Use of assistive technology, looking at peer mediated interventions for enhancing social skills and the use of social stories type of things. So there are practices that span a broad range of areas. This list is available on the materials for our website, and I will make sure that you have the link to the website where you can not feel like you have to capture every moment of this from looking at this list today so that you can go back and revisit it. And just to remind you, we think these evidence-based practices are delicious. [LAUGHTER] One of our professional development summer institutes, this cake was made to celebrate. So in case you wonder what to put on your next birthday cake. [LAUGHTER] This grid, which I know is not that easy to see either but it's also available in our resources, shows how this project, evidence-based practices, overlap with those of National Standards Project. 

And at a glance, what it says is there are a lot of practices in common. There are some we identified as having an evidence base that were still identified as emerging practices. So how did we go about translating the research into practice? We developed a number of learning materials on evidence-based practices and a process for validating that those practices were being implemented with what we call fidelity, which means if the research says you follow step A, B, C, D and E and that's what leads to an effective outcome, then we were working with schools and staff to say are you using all the steps. A lot of teachers say oh, yeah I know what peer mediated interventions are, and then when they looked at our checklist about all the steps that are involved in really doing it accurately they said, oh, I did this step but I didn't quite do this one, and we said, well, let's try and see what happens if we add all of those steps and see if you get a better outcome for the children that you're working with. So that gives you an idea of that translational piece where our aim is to bridge the gap. So there are, as I mentioned, a number of resources that we developed with our sort of what we're most proud of are these online modules that include those step by step instructions as well as a number of other supporting materials that I will show you in a moment. That site is offline today. I think they are doing some updating so I can't even link to it to show you, but it's right there. There are two ways to access it. One, through our site for this project on the Waisman Center's website, or two, through our national website through the FPG Institute at the University of North Carolina. 

So those are the materials that really support the professional development we've been providing to schools but also are available for anybody to access at no cost. So, those materials are there. There's also been sort of an online course on the basics of what is autism that the text of that is available, but through the Waisman Center we've set up an online course that is free and anybody can register, and more information about that is also available on the Waisman Center's website listed below. So these online modules that with think are the cornerstone of our legacy and the heart of our work, talk about all of the content, a description of what the practice is. They include pre- and post-tests. They have all downloadable information. They have case study examples. They have resources. They have suggested activities and discussion questions. And they include those checklists for that step by step implementation of those practices. 

So they're just a tremendous resource. They're embedded in part of the autism internet modules. Rather than develop our own site, we wanted to post them in a site that would be there when the project was gone, and the autism experiment modules include a tremendous number of information and educational modules for parents, for people with autism spectrums, for professionals who work with them, and all of our modules are embedded under evidence-based practices in that site. So we also were very careful that they were all validated by some of the professionals who actually did the research, and the way we wrote about them were reviewed by, like for the picture exchange communication, the developer of that, Andy Bondy, actually reviewed our module very carefully and said, yes, this is true to our intent of this system so thank you very much for getting this out there in another way to people in a very user friendly way. So then, as I've been talking about, we really focused on using those checklists in our practices to get to implementation. This is an example of what a checklist might look like. And I know our aim was to be user friendly and trying to merge details of research findings, and user friendly we've learned is a very big challenge. And so I think now that we've got the basic core of what that is, we're focusing a little bit more on making them a little bit more user friendly, but these are very accurate and reflect what is really important to be true to what the research says to implement these practices. So this is for one unnaturalistic interventions and starts step by step through activities such as identifying a target, collecting information on baseline which is probably a theme through many of these practices, taking a look at building in, how are we collecting data to see if we're doing this. For the teachers and educators who are working on it, there's a chance for them to check in with themselves to say, how are we doing in learning this practice? Are we integrating and using all of these steps? So that's the core materials that support our professional development activities, but we also look at a more comprehensive model including the quality of the program. 

And there is a graphic that goes with this that just disappeared. It's on my screen. Interesting. It was there when I, okay. So when we're looking at all these comprehensive elements of program quality, we are looking at the program quality, what the individual learner's goals are through their IP, their strengths and history and their teacher's knowledge. Let's see, oh, I see it comes in in pieces. There you go. And then we identify the evidence-based practices that fit for that individual child. So we're really looking from an individual child's perspective wrapping it around their individual goals, not a curriculum for a whole class, and then wrapping that into sort of a cyclical process of then what are we going to do, how did it go and where do we want to go back and refining these practices. So when we look at program quality, we have identified a number of indicators in that classroom or program environment that are conducive to a child making success, and there was an instrument called the autism program evaluation rating scale that was developed for this project that is not publicly available yet that looks at these elements of a classroom environment to see how those environments are organized in the context and climate of the school to actually support learning success for children with autism spectrum disorders. 

And we use this at the beginning and the end of our engagement with the school district to look at the environment as well as the individual practices. When we are looking at individual students, we have been starting with their IEP goals, and one of the things that we have discovered that a lot of IEP goals are not written in a way that you can really measure if progress is being made, particularly relevant to these evidence-based practices. So what we've done is started with the IEPs and really helped teachers, not change the IFSB because the general intention and area is really good, but to make modifications to scale it more discreetly so that we can go back and measure if progress towards these goals are being made as a result of using these practices. And for the children that have participated in our project, we've identified three priority goals. And we've used something called goal attainment scaling which focuses on sort of a continuum of what you expect that behavior to look like, and for children with autism we have really, really broken it down a lot. And as this one shows you, one of the key elements we've really focused on in breaking things down is how much prompting is being provided, how much doing for and what's the process that's helping that child learn to do this, this student learn to do this skill more independently or to assess. To be successful, how much support do they really need? And that's what this process has been invaluable for. I could talk hours for all of these aspects. So then we know that that's how we're trying to work, and the one thing we know is that, and this is where the whole field of professional development is going now, that you can't just go to a training and someone says here's what that practice is, now do it. We have discovered that the coaching process, along with professional development on the content, is essential to schools and educators and teams of professionals learning how to change their professional practices. 

So coaching has been an integral part of how we have worked with the schools and other early childhood programs in implementing this project. So we know that coaching is what helps sustain professional development, refines skills and it's a vehicle for developing that partnership and trusting relationship between someone who knows the content and has an idea of how to support and help a team or individual teacher or educator or therapist know what it's going to take to be able to practice in that way and to be available to them and have that trusting relationship. And mostly it includes sort of conferencing ahead of time, being on site to observe and then being able to meet afterward for discussions. And this is just an example of how our staff supported local coaches and school districts because our project is going to come and go, and we thought it was really important to support those who would be available for ongoing coaching when our project ended and we were no longer available. So we met with the coaches once a week, or once a month, and then the coaches work with their teams at least once month but more periodic basis. So I think I already mentioned that we know that coaching has the best promise for bringing around change. So what have we learned from our work? These slides are going to tell us a little bit about what we've used about teachers' increased use of evidence-based practices, improvements in quality program and also changes in outcome for learners. This is sort of our data from our first couple of years, but I think that without spending a lot of time, the tables are quite clear to show that from pre- and post-test measures that teachers are using for evidence-based practices if we look at before and after their involvement with our project. This slide shows the specific evidence-based practices that they're using more of, and one of the most dramatic on this to me is the use of visual supports. It is one of the most simple interventions, and it makes such a huge difference in the ability of a student with autism to navigate their way through a school day and learning activities. 

And so it was amazing how basic starting with that for so many people was and how powerful that was in making change. As an example: we looked at program quality through our rating scale and the program quality improved, pre- and post-engagement. At the elementary school with, actually, communication among team members within school from administrators with families being one of the areas that showed some of the greatest areas of improvement, and just qualitatively in our communications with school it was quite clear that that was a huge area of need to improve communication among everybody involved to sort of implement these practices and being able to identify if they're making a difference. In the high school, there was also change. And, again, looking in areas that are comparable. We also took a look at student learning about their engagement. So each of those five line bars on that table are addressing how we scaled those objectives that I showed you from those. So this shows you that a large number of the kids actually met their goals or exceeded them, and a few of the children made progress but did not meet their basic goal. And so some of the children that we worked with were really complicated learners, and so part of it was helping schools learn to set goals that actually would show change and achievement and be realistic and then providing the steps and the appropriate support. So in wrapping up, just wanted to highlight a couple of lessons that were learned. 

One is that in working with a school or a program, administrative buy-in and support is essential because it really takes time to bring people together to do this work and that a team approach works best. By definition, that team includes families, but we mean families when we say that. And that individual team members really need to understand what the content of the evidence-based practices are and what they looked like when they're practiced to fidelity. And if you're not familiar with the content, then it's really hard to have a common ground for communication about whether the team is effectively implementing all the different steps in the process of that practice. Coaching, professional development and ongoing support are essential and that use of data is essential to informed decision making and action. And I know there's huge initiatives in public education right now to focus more on using data to inform educational decisions, so this project fits right in with that, but we know that day-to-day, upfront staff working with kids have so many things to think about and collecting data is really important but it's really hard for them, realistically, to figure out how to do it. So we really spend a little bit of time thinking about how can we make it easy but make it important and part of the process. So, thank you very much. We have time for questions now. [APPLAUSE]