Preschool autism services: A tale of two Canadian provinces and the implications for policy

Abstract

For children with autism spectrum disorder (ASD), a lifelong neurodevelopmental condition, assessment and treatment services vary widely across Canada—potentially creating inequities. To highlight this, the Preschool Autism Treatment Impact study compared children’s services and outcomes in New Brunswick (NB) and Nova Scotia (NS). Diagnostic practices, service delivery models, wait times, and treatment approaches differed, as did children’s 1-year outcomes and costs for families and the public sector. Considering NB and NS strengths, we suggest that an optimal system would include: rapid access to high-quality diagnostic and intervention services; adherence to research-informed practice guidelines; interventions to enhance parents’ skills and self-efficacy; and measures to minimize financial burdens for families. Our results also suggest that provinces/territories must do more to ensure equitable access to effective services, including sharing and reporting on national comparative data. Canadian children with ASD deserve access to effective and consistent services, no matter where they live.

Why it is so challenging to perform economic evaluations of interventions in autism and what to do about it

“…Depending on the jurisdiction, this may be limited to a publicly subsidized healthcare system (Piccininni et al, 2017) or include a mix of public and private insurers. As noted, ASD programs may be subsidized by sectors external to health including child and youth services, social and community services, and education (Smith et al, 2021). Thus, it may be useful to consider a broader public payer perspective that includes nonhealth sectors (Hodgson et al, 2022).…”

“…Such evidence packages are used by NICE in the United Kingdom, the Canadian Agency for Drug and Technologies in Health (CADTH) (2017), the Institute for Clinical and Economic Review (ICER) (2020) in the United States, and other HTA agencies, although the components may differ across jurisdictions. As ASD programs may be subsidized by sectors external to health including child and youth services and education, HTA, and CUA specifically, have not traditionally been used to guide funding recommendations or policy (Shepherd & Waddell, 2015; Smith et al, 2021). Few rigorous economic evaluations of ASD interventions have been published and there is a lack of guidance on suitable approaches (Sampaio et al, 2022).…”

Competency drivers to support implementation of early intensive behavioral intervention in large-scale community-based services: Perspectives of caseworkers and organization representatives

“…Moreover, these results are consistent with those of Dionne, Paquet, Joly, Rousseau & Rivard (2016b) who also observed developmental gains in children from 14 Quebec institutions. More recently, Smith, Flanagan, Ungar, D'Entremont & Garon (2019), in Nova Scotia (Canada) published an article reporting gains related to adaptive behaviors and a reduction in challenging behaviors among young children with ASD who had participated in public EIBI programs funded by the health system. However, concerns persist regarding the establishment of EIBI within large-scale community-based services, notably regarding implementation fidelity.…”