With the world shutting down due to a global pandemic last year, many families and service providers of individuals with developmental disabilities in the United States have been learning to navigate the new world of modern technology in order to continue providing and receiving care. Distance learning and telehealth sessions have become a new normal for many of us. Despite potential challenges, did we learn anything new about using telehealth to provide care to the individuals we serve? Are these lessons important for the larger community beyond the United States?
I think the answers and yes and yes.
Using telehealth format for ABA service delivery.
Behavior analysis is one of the widely accepted approaches for the treatment of challenging behaviors associated with autism spectrum disorder and other developmental disabilities (CDC website). We will discuss using telehealth to deliver specifically Applied Behavior Analysis (ABA) services in this section and highlight some of the most recent available research.
One study was conducted in California over the course of several months after the shelter-in-place order was announced (Pollard et. al, 2021). ABA service recipients who wanted to continue receiving services were left with 2 choices: telehealth with a technician or telehealth caregiver training with direct caregiver implementation. There were 17 participants in total. According to Pollard et. al, “Participants continued to access similar dosage of treatment hours per week in spite of the treatment model transition and maintained or improved correct independent responding across all targets from in-person treatment to telehealth treatment” (p. 87). There was a 5% average improvement across targets for the participants, and these findings provide initial evidence that some clients with autism benefit from technician-delivered telehealth services.
Another recent study was conducted in Texas, where a team of researchers used telehealth to coach parents in conducting brief functional analyses to identify the function of their children’s challenging behaviors and implementing initial treatment (Gerow et. al, 2021). 7 families participated, and additional evaluations by trained providers supported the results of the functional analyses conducted by parents in 5 cases, with the other 2 participants not engaging in enough observable instances of challenging behavior to identify the function and continue treatment. This indicates that using telehealth to coach caregivers in implementing services may be an effective method for assessing and treating challenging behavior.
Other research on using telehealth for service delivery and training is available, including a few intercontinental studies like Barkaia et. al, 2017. This is unique because:
- Coaching to technicians was provided in English and Georgian while all services to participants were delivered in Georgian
- The study outcomes involve significant improvement of the technicians’ implementation skills after participating in telehealth coaching with certified behavior analysts in addition to measurable improvements on targets demonstrated by participants.
It is early to draw any conclusions, but there’s definitely more evidence available after the last year that supports the potential effectiveness of the telehealth model of delivering ABA services and training technicians and caregivers.
Why is it important to the world?
Behavior-analytic approach to treating challenging behaviors and finding functional alternatives primarily developed and evolved in the United States. ABA-based services in their modern form quickly became known as one of the effective approaches worldwide (thanks in part to modern technology), but that demand grew without the supporting training and regulating base. The Behavior Analyst Certification Board (BACB) is currently the only organization certifying behavior analysts internationally, meaning that only board-certified behavior analysts (BCBAs) are technically considered fully trained to deliver ABA services and provide coaching on service implementation.
Here is a random selection of numbers of active BCBAs available per some states and countries (bacb.org):
- United States – 1996 BCBAs in the state of MA
- United States – 107 BCBAs in the state of Nebraska
- United Kingdom – 321 BCBAs
- Australia – 111 BCBAs
- United Arab Emirates – 104 BCBAs
- Russian Federation – 33 BCBAs
- India – 27 BCBAs
- Spain – 26 BCBAs
- Brazil – 10 BCBAs
- Nigeria – 1 BCBA
I selected at least one country from each part of the world and two states from across the United States, and the message is clear – there are not nearly enough trained service providers for in-person services. Could using telehealth help solve that?
There is no definitive answer yet, more research is needed. Based on what we already know, there’s a good chance that using telehealth for service delivery and training might be part of the solution. Right now the answer is more of a “maybe” than a “yes”. Sharing this message with a larger community and continuing to measure the effectiveness of various telehealth training programs and interventions nationally and globally will lead to having a larger body of research to rely on and more informed ABA service providers and consumers everywhere.
Behavior Analyst Certification Board, http:/bacb.com/
Barkaia, Ana; Stokes, Trevor F.; Mikiashvili, Tamar (2017). Intercontinental telehealth coaching of therapists to improve verbalizations by children with autism. Journal of Applied Behavior Analysis, Volume 50 (3), 582-589.
Gerow, Stephanie; Radhakrishnan, Supriya; Davis, Tonya N.; Zambrano, Jacqueline; Avery, Suzannah; Cosottile, David W.; Exline, Emily (2021). Parent‐implemented brief functional analysis and treatment with coaching via telehealth. Journal of Applied Behavior Analysis, Volume 54 (1), 54-69.
Pollard, Joy S.; LeBlanc, Linda A.; Griffin, Christan A.; Baker, Joseph M. (2021). The effects of transition to technician‐delivered telehealth ABA treatment during the COVID‐19 crisis: A preliminary analysis. Journal of Applied Behavior Analysis, Volume 54 (1), 87-102.
Centers for Disease Control and Prevention, https://www.cdc.gov/ncbddd/autism/treatment.html