International Meeting for Autism Research: Increasing Accessibility to Behavioral Evaluation and Treatment Through Telehealth

Increasing Accessibility to Behavioral Evaluation and Treatment Through Telehealth

Friday, May 13, 2011
Elizabeth Ballroom E-F and Lirenta Foyer Level 2 (Manchester Grand Hyatt)
10:00 AM
T. Kopelman1, K. E. Pelzel2, D. P. Wacker3, S. D. Lindgren3, Y. Padilla4, J. F. Lee5 and D. B. Waldron3, (1)Iowa City, IA, (2)Center for Disabilities and Development, University of Iowa Hospitals and Clinics, Iowa City, IA, (3)Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, (4)Pediatrics, University of Iowa Children's Hospital, Iowa City, IA, (5)University of Iowa, Iowa City, IA
Background:  The effectiveness of behavioral procedures, including functional analysis (FA) and functional communication treatment (FCT), for decreasing problem behaviors displayed by some young children with autism spectrum disorders (ASDs) has been well-documented. Unfortunately, access to evidence-based behavioral services can be challenging in rural areas due to the limited availability of trained professionals. The use of telehealth may reduce barriers to accessing high quality behavioral services. To date, limited research has been published on the efficacy of using telehealth to conduct function-based evaluations and treatment with young children with ASDs.

Objectives:  This investigation will determine the efficacy of conducting FA and FCT via telehealth with young children (ages 18 months - 6 years) with ASDs who engage in problem behaviors, including aggression, destruction, and self-injury. Data on the number of children receiving behavioral services, the number of children with an identified social function identified by functional analysis, the mean decrease in problem behavior during functional communication, the costs of service delivery, and parent acceptability will be collected and compared with the outcomes of previous studies by the authors in which similar procedures were delivered in the home setting.

Methods:  Each child was evaluated in a university hospital outpatient clinic to confirm a diagnosis of ASD. Following confirmation, a FA of problem behavior (Iwata et al., 1982/1994) was conducted to identify the environmental variables maintaining the child's problem behaviors. FA sessions were conducted at a university-affiliated regional outpatient clinic located near the child’s home. Parents were provided with remote coaching on procedures from a behavioral specialist located the university hospital. FCT was initiated after completion of the FA. All FCT sessions were conducted by parents with coaching provided by behavioral specialists through telehealth. FA and FCT sessions lasted for 1 hour weekly for up to 6 months for each child. Sessions were conducted using H.323 compatible video conferencing software, with the Emblaze-VCON vPoint HD software running on Windows XP workstations. All sessions were recorded and later coded for both prosocial and disruptive behaviors.

Results: To date, FAs have been completed with 12 participants. A clear social function (escape and/or gain) has been identified for 10 of these children. FCT has been completed with 8 participants. The mean reduction in problem behavior after FCT treatment was 97%. Transportation costs and staff time are substantially lower when compared to the costs of sending behavioral therapists to children's homes ($58 versus $333 per child per week if services were provided in the home). Parent acceptability of treatment has been high (average rating of 5.9 on a 1-7 scale).

Conclusions:  Expanding access to behavioral services for children with ASDs is an urgent public need in rural states. Preliminary outcomes indicate that parents can be successfully coached using telehealth to conduct FA and FCT. Compared to an in-home service delivery model, the use of telehealth has resulted in increased efficiency (i.e., ability to conduct a greater number of evaluations within a standard of time), cost savings, and comparable reductions in problem behavior and treatment acceptability.

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