Ontario Autism Program: behaviour plans

Overview

An Ontario Autism Program behaviour plan (or plan) provides a detailed description of the evidence-based behavioural services that a child or youth receives in the Ontario Autism Program (OAP).

A behaviour plan is developed through collaboration between the family, the OAP clinical supervisor and other professionals as necessary.

While some families may receive multiple types of service, the OAP behaviour plan focuses exclusively on the evidence-based behavioural services that the child or youth is receiving through the OAP.

Families receiving childhood budgets are not required to submit behaviour plans to receive funding. Families may continue to find it valuable to have their child’s clinical supervisor develop an individualized behavioural service plan.

Transition to core clinical services

All children and youth who currently have a behaviour plan and continue to meet the eligibility criteria for the Ontario Autism Program will transition to core clinical services in 2023, starting in April.

Your transition timing depends on the end date of your current behaviour plan:

• Plans ending on or before March 31, 2023 – you can extend your plan for 6 months at its current level of intensity, or less where clinically appropriate. At the end of this 6-month extension, you will transition to core clinical services.
• Plans ending on or after April 1, 2023 – you will not be able to further extend your plan. When your plan ends, you will transition to core clinical services.

To ensure a seamless transition, you must:

• create an account with AccessOAP
• give consent for the ministry to transfer your/your child’s OAP record to AccessOAP

You must have an account with AccessOAP to transition to core clinical services and to have access to other OAP services. If you do not create an account with AccessOAP, you will not receive an invitation for core clinical services and your behaviour plan will not be renewed.

You should have received an email or letter from us about creating an AccessOAP account. The email/letter outlines three steps and includes a unique transition code.

For more details about creating your account with AccessOAP, please watch our video.

After you create your account, and before your behaviour plan ends, AccessOAP will contact you to schedule your or your child’s determination of needs interview. You must complete the determination of needs process to receive funding for core clinical services.

Once you create your AccessOAP account you can:

• schedule your determination of needs interview
• see the full list of programs and services available to you
• access your family OAP account information
• get the support you need to make the right decisions for you and your family

If you have questions about your behaviour plan, please contact your provider or clinical supervisor. If you need help creating your AccessOAP account, please contact AccessOAP:

• info@AccessOAP.ca
• Toll-free: 1-833-425-2445 (Monday – Friday, 8:30 a.m. – 5 p.m. Eastern Time)

Find behavioural services in your area

Autism Ontario has a list of clinical supervisors who oversee the delivery of behavioural services. This list can help you search for, select and confirm the qualifications of clinical supervisors.

You can hire a clinical supervisor who is not on the list if they:

1. are working towards the qualification requirements
2. complete the clinical supervisor attestation form

About clinical supervisors

As experts in assessment and behavioural interventions, clinical supervisors develop and recommend evidence-based behavioural services that are consistent with the Ontario Autism Program clinical framework.

To join the list, clinical supervisors must demonstrate they meet all the program’s qualification requirements.

Steps in the OAP behaviour plan development process

While each behaviour plan is unique to each child or youth and their family, there are a number of common steps in the planning process. With the family’s informed consent, the following steps are led by the OAP clinical supervisor.

Some tasks may be delegated to a professional under the clinical supervisor’s supervision.

Step 1: Information gathering

The OAP clinical supervisor begins by reviewing all relevant and available medical, educational and clinical community support documents about the child or youth, including the family service plan if available.

The clinical supervisor meets with the family and the child or youth to get to know their:

• strengths
• needs
• interests
• goals

The clinical supervisor will also gather information about the family’s highest areas of need related to the child, and contextual or practical factors relevant to the behavioural assessment and intervention, for example language and cultural considerations, transportation, scheduling constraints or other factors.

Step 2: Assessment

The clinical supervisor observes and directly assesses the child’s or youth’s performance to inform behavioural service goals and strategies, and to create a baseline for ongoing observation and assessment. The clinical supervisor will also assess the child’s or youth’s unique circumstances and family context.

The clinical team will obtain the family’s informed consent before conducting any assessments and will discuss the results with the family.

The scope of assessment is unique for each child or youth. The clinical supervisor determines the appropriate assessments based on the age, abilities and any individual challenges of each child or youth and their family. The clinical supervisor may consider other factors as part of the assessment, which can include personal strengths and interests, language and cultural considerations, and transportation and scheduling limits.

The assessment may take place in the child’s or youth’s home, school and/or in a clinical setting. The assessment may involve observing family-child interactions and/or school-based observations. The clinical supervisor may recommend focusing the assessment on specific domains or skills, including:

• social or interpersonal skills
• communication skills
• cognitive functions
• school-readiness skills
• motor skills
• personal responsibility or adaptive skills
• play and leisure
• self-regulation
• vocational skills
• challenging behaviours

To inform the assessment, the clinical team may use a combination of direct measures, such as functional behaviour assessments and/or curriculum-based assessments and documented evidence or data collected during a direct observation of the child. The clinical team may also use indirect measures, such as parent or school reports. In some cases, standardized tools can give more information.

The clinical team may also use prior assessments conducted by another professional to further inform key decisions in the planning, such as:

• psychological
• psychiatric
• pediatric
• speech and language
• occupational therapy assessments

Discuss the results of the assessment

Once direct and indirect assessments are completed, analyzed and summarized, the OAP clinical supervisor will share and discuss the assessment results with the family.

Together, the family and clinical supervisor develop a consensus-based common understanding of the child’s or youth’s priority goals and the plan for intervention. This may include both short- and long-term goals and priorities.

This consensus-based planning process continues throughout the child’s or youth’s experience in the Ontario Autism Program (OAP).

Regular reviews of the assessment

The clinical team conducts assessments through ongoing and regular reviews every six months, to assess progress and set goals. The team also uses ongoing data, such as skill acquisition and behaviour reduction to assess progress and inform clinical decision-making on a regular basis.

Step 3: Clinical recommendations

The clinical supervisor makes their recommendation about how much and what type of behavioural services the child or youth needs based on the information gathering and assessment process and the evidence from peer-reviewed literature. All recommendations will follow ethical practice and professional standards.

The clinical supervisor discusses their recommendations with the family and then begins developing the child or youth’s behaviour plan. The plan will include a description of the child’s or youth’s behaviours or skills, measurable goals and proposed interventions.

The plan will include details such as:

• family involvement
• scheduling
• setting
• anticipated duration
• roles and responsibilities of staff delivering the interventions
• how progress will be measured and assessed
• how skills will be generalized and maintained
• how next steps will be determined

With the family and their child or youth, OAP clinical supervisor will also determine the family’s involvement and other supports that are part of the recommended plan.

Step 4: Delivering a behaviour plan

The OAP clinical supervisor writes the behaviour plan as discussed with the family and their child or youth and with the involvement of other professionals as needed, including the family team if applicable. The clinical supervisor documents the clinical decision-making process, including the rationale for the recommended interventions and how the plan was discussed with the family.

The OAP clinical supervisor reviews the behaviour plan with the family and the child or youth and obtains their informed consent to proceed with the plan.

Written behaviour plans include:

• An OAP clinical supervisor attestation form completed and signed by the OAP clinical supervisor. This form confirms that the clinical supervisor is in compliance with the OAP guidelines and the OAP clinical framework, and that the clinical supervisor meets the OAP required qualifications or is working towards achieving these qualifications.
• OAP behaviour plan budget completed and signed by the OAP clinical supervisor, which is only used for direct funding providers or organizations.

Regional providers keep these documents in the child’s or youth’s case file. Direct funding providers submit these forms for a completion check to their local regional provider.

The behaviour plan must be signed by the clinical supervisor and one of the parents, guardian or youth (and in the case of direct funding providers, checked for compliance by the regional provider) before the clinical team starts delivers the services

Step 5: Delivery of behavioural services

The clinical team delivers services that are outlined in the behaviour plan.

As the child or youth masters new skills, the clinical team focuses on helping the child or youth extend and maintain these skills with other people and in a variety of settings, for example at home, school and in the community.

When the child or youth achieves the goals on their behaviour plan, the clinical supervisor introduces new targets to refine the behaviour plan.

Step 6: Monitoring and evaluating a behaviour plan

The clinical team monitors and evaluates the behaviour plan on an ongoing basis and provides regular progress updates to the family.

The OAP clinical supervisor writes a progress summary every six months and discusses it with the family. If needed, reviews can occur more frequently to respond to major changes in the child’s goals or strategies.

The progress summary includes:

• target skills or behaviours
• behavioural goals
• brief descriptions of the interventions
• results to-date based on documented evidence or data recommendations for next steps

The OAP clinical supervisor discusses and shares a copy of the summary with the family.

Behaviour plans are not static and should be monitored and evaluated on an ongoing basis to ensure a child’s or youth’s continuous progress. Monitoring and evaluation of the behaviour plan is the responsibility of the clinical supervisor. If a child or youth is not making progress, the clinical supervisor should examine and refine the behaviour plan.

Step 7: Revising a behaviour plan

If there are significant changes to the behaviour plan, for example a change in method to achieve a goal or new challenging behaviours, the clinical supervisor should amend the existing behaviour plan and show changes in how services will be delivered. Clinical supervisors providing services under the direct service option must submit this amendment to the single point of access.

The clinical supervisor communicates any changes in the behaviour plan to the family through their preferred means of communication (written updates, phone calls or in-person meetings). All verbal communication is documented in written form by the clinical supervisor.

Elements of the behaviour plan

The following elements must be included in all OAP behaviour plans. Service providers may prepare the behaviour plan in any format.

A signed copy of the behaviour plan should go to the:

• clinical supervisor
• OAP clinicians and frontline staff delivering the services
• parents or caregivers

1. Brief background information

Provide a summary of background information that is relevant to the child or youth’s behaviour plan. Note that further information can be found in the child or youth’s family service plan where appropriate.

Relevant background information could include:

• the family’s purpose in seeking behavioural services, including priorities and primary areas of concern
• history on the child or youth and their family, for example assessments, diagnoses and information about their school, work or living situation
• behavioural treatment plan history, for example services received in the past and a summary of progress from those interventions
• other types of services the child or youth and their family are currently receiving or waiting to receive, for example speech language therapy.

2. Summary of behavioural observations or assessment

This section must include:

• when and where the child or youth was observed
• which direct and indirect assessment tools were administered
• a summary of the results

Assessment results and reports should be attached to the behaviour plan. Direct assessments should be displayed with graphics when appropriate.

3. Strengths

Describe the child’s or youth’s strengths as identified in assessments and discussed with the family.

4. Domain(s) to be addressed

Describe each domain and skill that will be addressed. These skills can include:

• social or interpersonal
• communication
• cognitive functions
• school readiness
• motor skills
• personal responsibility or adaptability
• play and leisure
• self-regulation
• vocational
• challenging behaviour

Read the OAP guidelines for a complete list of domains and skills.

5. Intervention goals

This section must include:

• priority goals for each domain and skill to be addressed
• measurable targets for each goal
• defined methods for reaching and implementing each goal
• how the goals were developed, including family and child or youth involvement
• how the goals connect with broader family goals, as outlined in the family service plan

6. Skills to be developed

This section must include:

• a description of each skill that will be addressed
• baseline data
• how progress will be evaluated and measured

7. Behaviours to be decreased (if needed)

This section must include:

• a description of each behaviour that will be decreased, the function of the behaviour, history of related behaviours, consequence strategies and proposed replacement behaviours
• how change will be evaluated and measured

If none, indicate N/A.

8. Process for assessing interfering behaviours (if needed)

This section must include the process to evaluate interfering behaviours if they arise during intervention.
If none, indicate N/A.

9. Planned intervention and maintenance approach

Describe all elements of the planned intervention for all skills to be developed and behaviours to be reduced. Elements can include:

• type or style of intervention for each skill or behaviour identified. These interventions should factor in flexibility based on the child’s or youth’s learning. For example:
  • discrete trial
  • naturalistic
  • one-on-one
  • small group
  • parent training
• expectations for family involvement
• location in which services will be delivered
• number and duration of treatment sessions per week
• criteria for mastering each skill or behaviour identified
• reinforcement goals, including information about the type and schedule of reinforcement, for each skill or behaviour identified
• plans for implementation and maintenance of each skill across different people, settings, times and situations, and use of materials found in their surroundings. Planning can also include considerations for how to adapt different responses in various situations
• parent and mediator training procedures
• antecedent and consequent-based interventions, along with skill development and replacement behaviour goals

10. Evaluation plan

This section must include:

• how progress on each goal will be systematically and directly measured and assessed
• approximate review time frames to determine progress at least every six months, or sooner if clinically warranted
• how the behaviour plan’s effectiveness and intervention commitment will be monitored on an ongoing basis

Intervention strategies can be changed as needed. If the child or youth is not making progress, the OAP clinical supervisor should examine what has been done or could be done to refine the behaviour plan.

11. Risks and benefits

Describe the anticipated risks and benefits of the proposed interventions.

12. Roles of family or caregivers

Describe the role of family members, including their participation in the child’s or youth’s behaviour plan for:

• ongoing reviews, supervision or team meetings
• individual skill development or behaviour reduction
• factors for implementing behaviour plans such as scheduling and transportation

13. Roles and responsibilities of clinicians

This section must include:

• which clinicians or providers will deliver the services outlined in the plan
• who will clinically supervise each element of the plan and how often and for how many hours
• the nature of activities conducted during supervision, such as:
  • meeting with parents
  • meeting with other service providers
  • observation of the child or youth
  • data analysis and review
  • observation of therapists with the child or youth
  • evaluation of treatment effectiveness with therapists, parents or caregivers

14. Inter-professional collaboration

This section must include:

• a description of how the OAP; clinical supervisor or the clinical service delivery team will collaborate with other professionals as needed, for example the family team to review intervention notes, conduct phone calls or meetings, perform observation, develop goals
• frequency of these activities
• reference to the family service plan for more information where appropriate

15. Ongoing communication plan

Provide a schedule of family and provider touch points, including communication with the family team, if applicable.

16. Behaviour plan purpose, goals and family involvement

This section must include:

• OAP clinical supervisor’s reasoning for the elements of the plan
• dates of meetings and phone calls with the family to discuss the behaviour plan and names of participating family members
• if, how and when the child or youth participated in the meetings
• how the recommended plan was discussed with the family
• the family’s perspective about the plan

17. Additional information

Include additional information as required.

18. List of attached documents

List the name of each supporting document and the date it was completed. All assessment reports and graphs should be attached.

19. Signatures

The behaviour plan must have two signatures: the clinical supervisor’s signature and one of the parents, guardian or youth.
Include a parent, guardian, or youth’s signature together with the following statement:
My signature below confirms that:

• I fully understand the behaviour plan as explained by my OAP clinical supervisor.
• I understand the risks and benefits of the behaviour plan.
• I understand my role in supporting the planned intervention approach.
• I consent and agree to this behaviour plan.

Include the OAP clinical supervisor’s signature, together with the following statement:
My signature below confirms that:

• This behaviour plan complies with all elements of the OAP guidelines and OAP clinical framework.

Family service plan

Families with existing OAP behaviour plans can also choose to have a family service plan. The behaviour plan is a key component of the OAP family service plan and is developed by the OAP family support worker in collaboration with the family and other professionals as necessary.

The OAP family service plan captures the broader range of services and supports, activities, interests and goals of each child or youth and their family. It is a document that changes over time to reflect the changing priorities of the family, the child’s or youth’s developmental stage, progress toward specific goals and transition plans.

Addendum to Ontario Autism Program Guidelines and Behaviour plan budget template and instructions

Effective July 29, 2019

On July 29, 2019, the Ministry of Children, Community and Social Services announced steps to provide continuity of service while providing the necessary time to design a new needs-based autism program. 

The OAP Guidelines, OAP Clinical Framework, Clinical Supervisor Attestation form and OAP Behaviour Plan Budget Template, will continue to apply to all renewed Behaviour Plans, with some revisions. The following addendum outlines amendments to the OAP Guidelines and OAP Behaviour Plan Budget Template that apply as of July 29, 2019.

This addendum should be read in concert with the corresponding sections of the OAP Guidelines, OAP Behaviour Plan Budget Template, and OAP Behaviour Plan Budget Instructions.

Revision and addition to the OAP Behaviour plan budget template

Effective July 29, 2019

On page 1 of the OAP Behaviour Plan Budget, under “Submission guidelines”, replace:

“Budgets will be submitted and funded for a maximum of six months. Any budgets submitted for a duration longer than six months will be returned to the OAP provider submitting the budget and will need to be submitted again”.

with:

“Budgets will be submitted and funded for a maximum of six months. Any budgets submitted for a duration longer than six months will be returned to the OAP provider submitting the budget and will need to be submitted again. The service hours a child receives per week in any renewed Behaviour Plan must be equal to or less than the service hours they received per week in their previous plan”.

Revision and addition to the OAP Behaviour plan budget instructions

Effective July 29, 2019

In Part A of the OAP Behaviour Plan Budget, under “Submission guidelines”, replace:

“Budgets will be submitted and funded for a maximum of six months. Any budgets submitted for a duration longer than six months will be returned to the OAP provider submitting the budget and will need to be submitted again”.

with:

“Budgets will be submitted and funded for a maximum of six months. Any budgets submitted for a duration longer than six months will be returned to the OAP provider submitting the budget and will need to be submitted again. The service hours a child receives per week in any renewed Behaviour Plan must be equal to or less than the service hours they received per week in their previous plan”.

Questions about existing behaviour plans

If your child is receiving services through an OAP behaviour plan and you have questions about their existing behaviour plan, please contact your current service provider or family support worker. Contact a family support worker in your region:

• Western Ontario
• Central Ontario
• Northern Ontario
• Eastern Ontario
• Toronto

Western Ontario

Central Ontario

Northern Ontario

Eastern Ontario

Toronto