Intensive Developmental Services
The Early Intervention Model at the Charles St Clinic has been developed by Darin Cairns. Darin has been managing and designing services such as these for almost 20 years and has overseen the developmental programs of over 500 children with Autism Spectrum Disorders or related conditions.
Darin has lectured around the world on his work on applications of Learning Theory (Applied Behavioural Analysis) to child and human development across the lifespan. Darin has a specific interest in advanced human capacities and this has led him to further study Relational Frame Theory and Contextual Behavioural Science. This has given learning theorists insight into significant empathy, theory of mind, narrative and reasoning skills and how these lead to lasting social development and sound mental health. For more information on ACBS and RFT applications in education and development see http://anzact.com/education-and-development/
To maintain quality of our program, we have no more than 50 children participating in our program at any one time. We will not see any more than 50 children as we believe therapy quality can drop due to difficulty in providing appropriate supervision, guidance and support to our therapy team. Due to this decision we do not keep waitlists as we cannot predict with confidence when places will be available. We may have spaces at any time during the year depending on if children have completed our program or reduced hours.
Our model is based on Applied Behavioural Analysis because it has far and away the most overwhelming amount of evidence to support its efficacy. The National Standards Project (2015)found behavioural education had by far the most evidence of all proven interventions for children with Autism Spectrum Disorder.
However, in our community, ABA therapies can also cause a great deal of confusion.
Let us break it down for you…
ABA is a scientific approach for understanding how people learn. As such it can be applied in many ways. For example, one application may be to use a highly structured ‘table top’ approach with a heavy focus on repetition, explicit prompting and reward based motivation. However, another approach may be to work on natural social interaction where the prompts are natural (like watching others) and the motivation is social (e.g. simply getting noticed or being invited to play). So there are many ways to implement ABA based programs. We have listed some of these below:
Natural Environment Teaching;
Pivotal Response Teaching;
Verbal Behavioural Analysis;
Lovaas influenced Discrete Trial Teaching
At the Charles Street Clinic all of these methods are used. ABA uses a transparent measurement approach, which makes it easier for therapists and parents to evaluate if it is helping or not. At Charles St Clinic, based on the data and the parent and therapist’s feedback, your child’s program is designed in a highly individualized fashion and this may utilize all or only one of the approaches mentioned above.
Our model is also characterized by it’s application of Relational Frame Theory (RFT). RFT is a theory explaining language and cognition, through the acquisition of derived stimulus relations. It explains while some concepts are explicitly taught (example, Jack is taller than Jill), others are inferred (so Jill must be smaller than Jack). The ability to derive information this way is called derived relational responding (DRR).
Research shows developing skills in DRR can:
Assist in early language acquisition
Improve basic reasoning
Help in metaphor and analogy development
Improve perspective taking
Improve cognitive development
(ANZ ACBS, 2016)
We also offer parent training in the form of NET (natural environment training), which empowers families to take away skills learnt in therapy and apply them in natural settings.
There are numerous service models that can be applied in developmental programs (for example the Denver Early Start Model). In Western Australia a number of different types of models are used. Including centre based group models, weekly clinic based consultation and home based services. All models come with pro’s and con’s. Centre based and home models are the most common. Centre based models allow for ‘school’ type settings and provided the children are well matched in groups, this can be an effective way to work on social development and prepare for school. Home-based models allow for the child to work within their family home and system. The advantage of this approach is that it allows for more naturalistic play based models but it also allows for more family involvement. Furthermore, therapists can work more collaboratively with families to identify goals and strategies for the child.
Related to the question of delivery is the question of goal setting. There are many ways to identify and assess the appropriateness of goals and strategies being applied for the child. We have listed the common ways below:
Data collection is an important part of ABA therapy, not only to evaluate the effectiveness of therapy but to also guide appropriate goal setting. As such, at The Charles St Clinic, data is recorded at every therapy session and reviewed on a monthly basis. Data collection may include recordings of target skill acquisition or targeted behaviour reduction.
Therapy is provided by our Developmental Therapists. Our Developmental Therapists have all completed or are completing degrees in Occupational Therapy (OT), Speech Pathology, Psychology or Education. We also employ Developmental Therapists if they have worked directly with children for over 2 years and complete our training.
Every month a review meeting is held with our client (the parent and child), Developmental Therapist and Case Manager. Your child’s data is reviewed in addition to general progress in other developmental domains. A new program for the Developmental Therapist and strategies for the family are established in this meeting. Case Manager’s (CM) have at least 1000 hours of experience in providing therapy and meet with Consultant staff regularly.
Consultant Therapists including Speech Pathologists (SP), and Psychologists (PSYCH) can be found on the Home Page. Children and families will access specialist consultant services on a needs basis and the consultant and case manager will liaise regularly. For example, a child may see the Speech Pathologist (SP) weekly due to complex needs or detailed assessment and the SP will feedback insights and input to the Case Manager to assist with the intensive developmental therapy being done at home. However, the SP may later determine that the bulk of the therapy can be effectively delivered by the Developmental Therapist and reduce her sessions to monthly. This will continue to vary based on the child’s results and needs throughout their time in our program.
A graphic showing the communication and service delivery for the Charles Street Clinic Model can be seen below;
Ethics and Philosophy
The Charles Street Clinic is firmly founded upon a belief in evidence-based practice and that therapy must be informed by science. Our overall goal is to:
Empower children to become independent learners who can navigate their worlds in a meaningful and secure way.
Empower families to be able to parent and raise their children in a valued and meaningful way.
Enrich and support all the contexts a child exists within to maximise the child’s potential.
RELEVANT READING AND RESOURCES
Presentations by Darin Cairns:
Also refer to our Links page