System for Facilitating Model-Driven Behavioral Therapy

Background:  Evidence-based, early intensive interventions such as the Early Start Denver Model, are based on rigorous, structured curriculums (Dawson et al., 2010; Rogers et al., 2012) and established learning principles and approaches (McEachin et al., 1993).  These approaches create individualized treatment plans from libraries of objectives, either formal or informal, that cover a range of domains and clear mastery criteria.  Such interventions may be difficult to implement in community settings where therapy is delivered by tutors under the supervision of program managers.  Existing therapy management systems do not accommodate the creation of new structured models, importing existing models, or provide ways for supervisors to monitor adherence to such models. Innovative therapy management software is needed to support the adoption of evidence-based approaches and allow therapists to deliver model-driven programs in a wider variety of settings and communities.

Objectives:  We are developing a system (Abacus, NIH SBIR 1R43MH098476-01A1, Jakobovits PI), that will allow therapy practice directors to create and import structured models, tailor them to fit their own practice approach, and use them as templates governing the creation of curriculums within their organization.  The software will enable program managers to construct and refine individual therapy curriculums based on the proscribed model, and efficiently supervise tutors who will use a tablet app to deliver therapy within the model.

Methods:  We are building a prototype which is being evaluated by researchers at the University of Washington Autism Center (UWAC) and community service providers at Northwest Behavioral Associates (NBA).  The system consists of four main components: (1) Therapy App: a tablet-based data collection platform that allows tutors to stay continuously connected with the child throughout the session, while at the same time ensuring that all treatment objectives are met; (2) Curriculum Tuner: an online tool for managing individualized curriculums, drawing from shared objectives libraries; (3) Team Dashboard: a web-based solution for monitoring treatment dosage, objectives coverage, and fidelity across practitioners; and (4) Parent Portal: a user-friendly interface for engaging parents as active participants in the structured delivery of the intervention.    

Results:  We have developed a prototype and are in the process of generating detailed qualitative measurements of the feasibility of 14 key functions of the system.  The NBA model (2500 templates) has been imported into the system, and interventionists have begun assessing its functionality.  Preliminary findings indicate overall high user satisfaction and ease of use.  Functional analysis demonstrates high usability; program managers are able to successfully create tailored treatment plans, and tutors are prompted to move to the next learning step in every instance where mastery criteria was completed. We will present this system and preliminary findings, including results from user surveys and feasibility measures.

Conclusions:  Abacus represents a more efficient mechanism for conducting intervention and adhering to a structured models, including user-friendly interfaces for creating, adjusting, and monitoring individualized curriculums, and for performing rigorous data collection and analysis.  This new technology has the potential to accelerate the adoption of emerging behavioral interventions and ultimately contribute to the evolution of the field of autism treatment.