The Challenges of Individualizing Early Intervention in a Context of Large-Scale Services

Background: For more than 15 years, the Quebec government, through health and social services organizations, has offered early behavioral intervention (EBI) to young children with autism. These services were organized on the basis of scientific knowledge, but also on the particular realities and challenges of each of the regions concerned. A provincial study has documented the different choices that institutions have made across the province, including the choice to offers EBI in inclusive child care settings for a majority of children (Dionne et al., 2016). However, to date, a limited number of studies have focused on large-scale community-based EBI services (Eikeseth, Långh, Hammar, Klintwall, & Bölte, 2018, Eikeseth, Klintwall, Jahr, & Karlsson, 2012). In a collaborative research perspective, studies conducted over the last few years with skateholders that are implementing EBI in context of large-scale public services in Quebec. One of the aspects of the intervention addressed in these studies is the individualization of practices in order to consider the unique needs of each child, the realities of his family and his living environment, as well as the resources available.

Objectives: General objective is to document the practices of clinical team members with respect to intervention planning in the context of EBI in the context of large-scale public services. More specifically, the following objectives will be addressed: 1) describe the level of individualization of EBI programs by analyzing intervention plans and evaluating their quality, 2) describe the variables considered by professionals when choosing strategies for intervention, 3) describe the decision-making process with respect to these choices.

Methods: A mixed method, combining data from various sources (interviews, questionnaires, intervention plans analysis) was used. A total of 23 participants (supervisors and practitioners) from 3 rehabilitation centers participated in the project. In addition, a total of 37 intervention plans were analyzed.

Results: Most frequently targeted areas of development for intervention plans are communication, followed by cognitive skills. A variety of evidence-based intervention strategies are implemented (eg, discrete trial teaching, reinforcement, visual support). When it comes to choosing these strategies, according to the results to the questionnaire, respondents consider child characteristics (m = 4.35), family characteristics (M = 4.31), as well as those of the child care setting (M = 4.17) as very important. All the supervisors interviewed mentioned the need to consider a set of child characteristics. Among those mentioned by a majority : level of language and communication (100%), the progression of the child (100%), impairments or associated health problems (88.9%), level of development (88.9%), but also, sensory characteristics (66.7%), chronological age (66.7%), interactions and social skills (66.7%), attention span (55.6%), ASD severity (55.6%) and child interests (55.6%).

Conclusions: The choice of intervention strategies is a complex process based on the analysis of a large number of factors. The absence of a clear protocol to frame EBI services certainly contributes to complicate this process. The clinical support offered by the organizations is therefore essential, although very variable across organization. Different clinical supports should be developed to support teams implementing EBI within community services.