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Zhang Y, Stayt L, Sutherland S, Greenway K. How clinicians make decisions for patient management plans in telehealth. J Adv Nurs 2024; 80:3516-3532. [PMID: 38380577 DOI: 10.1111/jan.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/23/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM This systematic integrative literature review explores how clinicians make decisions for patient management plans in telehealth. BACKGROUND Telehealth is a modality of care that has gained popularity due to the development of digital technology and the COVID-19 pandemic. It is recognized that telehealth, compared to traditional clinical settings, carries a higher risk to patients due to its virtual characteristics. Even though the landscape of healthcare service is increasingly moving towards virtual systems, the decision-making process in telehealth remains not fully understood. DESIGN A systematic integrative review. DATA SOURCES Databases include CINAHL, APA PsycInfo, Academic Search Complete, PubMed, Web of Science and Google Scholar. REVIEW METHODS This systematic integrative review method was informed by Whittemore and Knafl (2005). The databases were initially searched with keywords in November 2022 and then repeated in October 2023. Thematic synthesis was conducted to analyse and synthesize the data. RESULTS The search identified 382 articles. After screening, only 10 articles met the eligibility criteria and were included. Five studies were qualitative, one quantitative and four were mixed methods. Five main themes relevant to decision-making processes in telehealth were identified: characteristics of decision-making in telehealth, patient factor, clinician factor, CDSS factor and external influencing factor. CONCLUSIONS The decision-making process in telehealth is a complicated cognitive process influenced by multi-faceted components, including patient factors, clinician factors, external influencing factors and technological factors. IMPACT Telehealth carries higher risk and uncertainty than face-to-face encounters. CDSS, rather than bringing unification and clarity, seems to bring more divergence and ambiguity. Some of the clinical reasoning processes in telehealth remain unknown and need to be verbalized and made transparent, to prepare junior clinicians with skills to minimize risks associated with telehealth. PATIENT OR PUBLIC CONTRIBUTION Not applicable.
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Affiliation(s)
- Yuhan Zhang
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
| | - Louise Stayt
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
- Oxford Brookes University, Oxford, UK
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Albright J, Shinall JA, Tomczuk L, Stewart RE, Mandell DS, Stahmer AC, Beidas RS, Pellecchia M. A multi-constituent qualitative examination of facilitators and barriers to caregiver coaching for autistic children in publicly funded early intervention. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241272993. [PMID: 39171756 DOI: 10.1177/13623613241272993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
LAY ABSTRACT Caregiver coaching is an evidence-based practice for young autistic children, but it is not widely used in community-based early intervention services. Previous research has explored why caregiver coaching is not widespread in early intervention, but only from the perspective of early intervention providers. Caregivers, providers, and administrators are all involved in the decision of whether to use caregiver coaching in early intervention. Therefore, it is important to include all perspectives in research regarding this practice. In this study we interviewed 20 caregivers of autistic children, 36 early intervention providers, and 6 administrators from early intervention agencies and asked questions about their perspectives regarding the use of caregiver coaching in early intervention. We did this to figure out what factors help and hinder the use of caregiver coaching in this setting and to see how caregivers, providers, and administrators agreed or disagreed on these factors. All participants agreed that caregivers' attitudes and expectations can influence whether caregiver coaching is used. In addition, all participants agreed that when caregivers and providers collaborate and have a strong working relationship, it can facilitate the use of caregiver coaching in early intervention. Other factors, such as caregiver stress and provider flexibility were also discussed. Based on these findings, we suggest strategies that can be used to possibly increase the use of caregiver coaching in early intervention for autistic children and their families.
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Affiliation(s)
| | | | | | | | | | | | - Rinad S Beidas
- Northwestern University Feinberg School of Medicine, USA
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3
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Graber A, Maguire A. Clinical Informed Consent and ABA. Behav Anal Pract 2024; 17:389-400. [PMID: 38966258 PMCID: PMC11219615 DOI: 10.1007/s40617-023-00902-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 07/06/2024] Open
Abstract
The practice of clinical informed consent in America is governed by over 100 years of case law. Although predominant ethics resources for behavior analysts offer some guidance regarding the provision of clinical informed consent, such guidance remains limited. The goal of this article is thus to expand the contemporary literature on clinical informed consent in behavior analysis by providing a historical and contemporary guide to relevant case law. The article will highlight seminal moments in the history of case law regarding clinical informed consent, discuss their applicability to the process of clinical informed consent in behavior analysis, and provide an enhanced understanding of the ethical and legal obligations related to informed consent in the therapeutic context. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00902-0.
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Affiliation(s)
- Abraham Graber
- Division of Bioethics, Nisonger Center Affiliate Faculty, Department of Biomedical Education and Anatomy, Wexner College of Medicine, The Ohio State University, Columbus, OH USA
| | - Allison Maguire
- Department of Athletics, University of Texas at San Antonio, San Antonio, TX USA
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Passamani RS, Shigihara CK, Gomes PG, Dos Santos AN. Agreement of synchronous remote and in-person application of the Alberta Infant Motor Scale: Cohort study. J Telemed Telecare 2024:1357633X241245160. [PMID: 38659374 DOI: 10.1177/1357633x241245160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Using standardized scales to assess motor development via telemedicine can increase access for low-income populations. Our aim was to verify the agreement and feasibility between remotely and synchronously applying the Alberta Infant Motor Scale (AIMS) and the in-person format. METHODS This was a concordance study, with 77 typical infants aged 4-18 months (mean = 13 months). The AIMS was applied remote via video calls and face-to-face. We applied a questionnaire to caregivers to verify feasibility. RESULTS There was a high level of agreement between the remote and in-person assessments, with intraclass correlation coefficients above 0.98 and low standard error measure values (<1 item for each posture, <2 items for the total raw score, and =5% for the normative score). The smallest detectable change was between 1.67 and 2.45 for each posture, 3 for the total raw score, and 6% for the normative score. The Bland-Altman analysis showed low bias with the mean difference close to zero (<0.80) and low error with little dispersion of the difference points around the mean. Caregivers' perspectives on the synchronous remote assessment were positive, with good quality, clear information during the assessment, and comfort with the method. DISCUSSION The synchronous remote application of the AIMS may be an alternative for families without access to in-person services that assess motor development.
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Affiliation(s)
- Rafaela S Passamani
- Department of Health Science, Universidade Federal de Santa Catarina, Santa Catarina, Brazil
| | - Carolina K Shigihara
- Department of Health Science, Universidade Federal de Santa Catarina, Santa Catarina, Brazil
| | - Paula G Gomes
- Department of Health Science, Universidade Federal de Santa Catarina, Santa Catarina, Brazil
| | - Adriana N Dos Santos
- Department of Health Science, Universidade Federal de Santa Catarina, Santa Catarina, Brazil
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Sipila-Thomas ES, Brodhead MT. A Survey of Barriers Experienced while Providing Supervision via Telehealth: Implications for Future Research and Practice. Behav Anal Pract 2024; 17:70-86. [PMID: 38405286 PMCID: PMC10891024 DOI: 10.1007/s40617-023-00860-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 02/27/2024] Open
Abstract
Telehealth is an acceptable service delivery mechanism for applied behavior analytic interventions and has led to positive outcomes for decreasing problem behavior and increasing skill acquisition in individuals with autism spectrum disorder. Literature regarding best practices for providing behavior analytic services via telehealth has increased; however, limited literature exists on training, best practices, implementation guidelines, and troubleshooting resources when providing supervision to supervisees via telehealth. Therefore, the purpose of this study was to understand the barriers to supervision via telehealth of BCBAs and those pursuing their BCBA credential. Following survey distribution and completion, participant data were analyzed for specific barriers encountered while providing behavioral supervision during telehealth and the strategies participants used to address or mitigate those barriers. Based on our findings, we also present troubleshooting resources and recommendations to help supervising behavior analysts prepare for and mitigate any supervisory barriers that may occur in the future.
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Affiliation(s)
- Emma S. Sipila-Thomas
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI 48824 USA
| | - Matthew T. Brodhead
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, 620 Farm Lane, East Lansing, MI 48824 USA
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Bray M, Turner J, Jones S, Miah T, Milberger S. Developing Workforce Skills and Capacity in Telehealth: What LEND Trainees Need to Know. Matern Child Health J 2024; 28:240-245. [PMID: 37889391 DOI: 10.1007/s10995-023-03794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION The COVID-19 pandemic significantly impacted the way health-related services are delivered, rapidly shifting from in-person to telehealth visits. To ensure that future healthcare providers are fully prepared to deliver services to families of youth with neurodevelopmental disabilities (NDD), understanding telehealth's advantages and barriers is vital. To this end, data were gathered to inform the development of a nationally available telehealth curriculum aimed at training future healthcare professionals from the Leadership Education in Neurodevelopmental Disabilities (LEND) network. METHODS Surveys were sent out nationally to current LEND trainees, practicing healthcare professionals, and family members of youth with NDD in November of 2020. Multiple choice and free response questions were completed and analyzed. A total of N = 208 surveys were completed (88 LEND trainees, 94 practicing professionals, 23 family members). RESULTS Most survey respondents reported having positive experiences with telehealth. LEND trainees and current healthcare professionals cited increased access to care and engagement as the top benefit of telehealth. Most family members reported using telehealth services (78%) and felt it was superior to in-person visits in terms of location of visit, scheduling, and meeting transportation needs. Trainees and professionals agreed the top barriers to telehealth for families were lack of broadband access and complexity of implementation and use. LEND trainees agreed telehealth basics should be included in LEND curriculum. DISCUSSION Trainees, professionals, and family members all agreed that knowing the basics of telehealth is essential for effective telehealth service delivery. Emerging healthcare professionals need to understand how those they will be serving engage with technology, their levels of experience in this area, and effective strategies for engaging children and youth with NDD through telehealth. This will bridge the engagement gap many families of children with disabilities face when not meeting in person. Findings from this study contributed to the design of learning materials that currently support LEND trainees across the country in developing these skills.
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Affiliation(s)
- Michael Bray
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA.
| | - Jane Turner
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sean Jones
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Tazia Miah
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
| | - Sharon Milberger
- Michigan Leadership Education in Neurodevelopmental and related Disabilities (MI-LEND), Wayne State University, Detroit, MI, USA
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Ferrante C, Sorgato P, Fioravanti M, Pacione L, Arduino GM, Ghersi S, Scattoni ML, Servili C, Salomone E. Supporting Caregivers Remotely During a Pandemic: Comparison of WHO Caregiver Skills Training Delivered Online Versus in Person in Public Health Settings in Italy. J Autism Dev Disord 2024; 54:765-784. [PMID: 36454366 PMCID: PMC9713075 DOI: 10.1007/s10803-022-05800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2022] [Indexed: 12/05/2022]
Abstract
Feasibility, acceptability and effectiveness data of a virtual adaptation of the WHO Caregiver Skills Training (CST; n = 25) were compared with those of a pilot RCT of CST delivered in person (n = 43) against treatment as usual (TAU; n = 43). Virtual CST was delivered with high levels of integrity, but received lower ratings in some caregiver- and facilitator-rated acceptability and feasibility dimensions. Qualitative analysis identified both benefits (flexibility, convenience, clinical usefulness) and challenges, (technological issues, distraction from family members, emotional distance). Virtual and in-person CST improved significantly more on caregiver competence than TAU; there were no other significant effects. Potential for use of virtual CST as a clinical response in contexts where in-person delivery is not possible is discussed.
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Affiliation(s)
- Camilla Ferrante
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Paola Sorgato
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Mariachiara Fioravanti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy
| | - Laura Pacione
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Giuseppe Maurizio Arduino
- Centro Autismo e Sindrome di Asperger, Ospedale Regina Montis Regalis Mondovì, Mondovì (Cuneo), Italy
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Erica Salomone
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milan, Italy.
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.
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Peskin A, Barth A, Andrew Rothenberg W, Turzi A, Formoso D, Garcia D, Jent J. New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy. Behav Ther 2024; 55:106-121. [PMID: 38216225 DOI: 10.1016/j.beth.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 01/14/2024]
Abstract
Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.
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Pazol K, Tian LH, DiGuiseppi C, Durkin MS, Fallin MD, Moody EJ, Nadler C, Powell PS, Reyes N, Robinson B, Ryerson AB, Thierry JM, Tinker SC, Wiggins LD, Yeargin-Allsopp M. Health and Education Services During the COVID-19 Pandemic Among Young Children with Autism Spectrum Disorder and Other Developmental Disabilities. J Dev Behav Pediatr 2024; 45:e31-e38. [PMID: 38364085 PMCID: PMC10963045 DOI: 10.1097/dbp.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/29/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Understanding how the COVID-19 pandemic affected children with disabilities is essential for future public health emergencies. We compared children with autism spectrum disorder (ASD) with those with another developmental disability (DD) and from the general population (POP) regarding (1) missed or delayed appointments for regular health/dental services, immunizations, and specialty services; (2) reasons for difficulty accessing care; and (3) use of remote learning and school supports. METHOD Caregivers of children previously enrolled in the Study to Explore Early Development, a case-control study of children with ASD implemented during 2017 to 2020, were recontacted during January-June 2021 to learn about services during March-December 2020. Children were classified as ASD, DD, or POP during the initial study and were aged 3.4 to 7.5 years when their caregivers were recontacted during the pandemic. RESULTS Over half of all children missed or delayed regular health/dental appointments (58.4%-65.2%). More children in the ASD versus DD and POP groups missed or delayed specialty services (75.7%, 58.3%, and 22.8%, respectively) and reported difficulties obtaining care of any type because of issues using telehealth and difficulty wearing a mask. During school closures, a smaller proportion of children with ASD versus another DD were offered live online classes (84.3% vs 91.1%), while a larger proportion had disrupted individualized education programs (50.0% vs 36.2%). CONCLUSION Minimizing service disruptions for all children and ensuring continuity of specialty care for children with ASD is essential for future public health emergencies. Children may need additional services to compensate for disruptions during the pandemic.
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Affiliation(s)
- Karen Pazol
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lin H. Tian
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Carolyn DiGuiseppi
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | | | - Eric J. Moody
- University of Wyoming Institute for Disabilities, Laramie, WY
| | - Cy Nadler
- Children’s Mercy Kansas City, Kansas City, MO
| | - Patrick S. Powell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Nuri Reyes
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Britney Robinson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - JoAnn M. Thierry
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lisa D. Wiggins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
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Call NA, Bernstein AM, O’Brien MJ, Schieltz KM, Tsami L, Lerman DC, Berg WK, Lindgren SD, Connelly MA, Wacker DP. A comparative effectiveness trial of functional behavioral assessment methods. J Appl Behav Anal 2024; 57:166-183. [PMID: 38049887 PMCID: PMC10843530 DOI: 10.1002/jaba.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023]
Abstract
Clinicians report primarily using functional behavioral assessment (FBA) methods that do not include functional analyses. However, studies examining the correspondence between functional analyses and other types of FBAs have produced inconsistent results. In addition, although functional analyses are considered the gold standard, their contribution toward successful treatment compared with other FBA methods remains unclear. This comparative effectiveness study, conducted with 57 young children with autism spectrum disorder, evaluated the results of FBAs that did (n = 26) and did not (n = 31) include a functional analysis. Results of FBAs with and without functional analyses showed modest correspondence. All participants who completed functional communication training achieved successful outcomes regardless of the type of FBA conducted.
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Affiliation(s)
- Nathan A. Call
- Marcus Autism Center, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alec M. Bernstein
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Matthew J. O’Brien
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Kelly M. Schieltz
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Loukia Tsami
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Dorothea C. Lerman
- Center for Autism and Developmental Disabilities, University of Houston-Clear Lake, Houston, Texas, USA
| | - Wendy K. Berg
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Scott D. Lindgren
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
| | - Mark A. Connelly
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - David P. Wacker
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, USA
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Mira JJ, Ballester P, Gil-Hernández E, Sambrano Valeriano L, Álvarez Gómez E, Olier Garate C, Márquez Ruiz Á, Acedo Torrecilla M, Arroyo Rodríguez A, Hidalgo Galache E, Navas Gutiérrez P, Pérez-Jover V, Lorenzo Martínez S, Carrillo Murcia I, Fernández Peris C, Sánchez-García A, Vicente Ripoll MA, Cobos Vargas Á, Pérez-Pérez P, Guilabert Mora M. Safe Care and Medication Intake Provided by Caregivers at Home: Reality Care Study Protocol. Healthcare (Basel) 2023; 11:2190. [PMID: 37570430 PMCID: PMC10419200 DOI: 10.3390/healthcare11152190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
JUSTIFICATION Providing care to patients with several conditions and simultaneously taking several medications at home is inexorably growing in developed countries. This trend increases the chances of home caregivers experiencing diverse errors related with medication or care. OBJECTIVE To determine the effectiveness of four different educational solutions compared to the natural intervention (absence of intervention) to provide a safer care at home by caregivers. METHOD Prospective, parallel, and mixed research study with two phases. Candidates: Home-based caregivers caring a person with multiple comorbid conditions or polymedication who falls into one of the three profiles of patients defined for the study (oncology, cardiovascular, or pluripathological patients). First phase: Experts first answered an online survey, and then joined together to discuss the design and plan the content of educational solutions directed to caregivers including the identification of medication and home care errors, their causes, consequences, and risk factors. Second phase: The true experiment was performed using an inter- and intrasubject single-factor experimental design (five groups: four experimental groups against the natural intervention (control), with pre- and post-intervention and follow-up measures) with a simple random assignment, to determine the most effective educational solution (n = 350 participants). The participants will be trained on the educational solutions through 360 V, VR, web-based information, or psychoeducation. A group of professionals called the "Gold Standard" will be used to set a performance threshold for the caring or medication activities. The study will be carried out in primary care centers, hospitals, and caregivers' associations in the Valencian Community, Andalusia, Madrid, and Murcia. EXPECTED RESULTS We expect to identify critical elements of risk management at home for caregivers and to find the most effective and optimal educational solution to reduce errors at home, increasing caregivers' motivation and self-efficacy whilst the impact of gender bias in this activity is reduced. TRIAL REGISTRATION Clinical Trial NCT05885334.
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Affiliation(s)
- José Joaquín Mira
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d’Alacant, Spain; (P.B.); (E.G.-H.); (A.S.-G.)
| | - Pura Ballester
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d’Alacant, Spain; (P.B.); (E.G.-H.); (A.S.-G.)
- Departamento Farmacología, Universidad Católica de San Antonio de Murcia, 30107 Murcia, Spain
| | - Eva Gil-Hernández
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d’Alacant, Spain; (P.B.); (E.G.-H.); (A.S.-G.)
| | | | | | - Clara Olier Garate
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain; (C.O.G.); (S.L.M.)
| | | | | | | | | | | | - Virtudes Pérez-Jover
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
| | | | - Irene Carrillo Murcia
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
| | - César Fernández Peris
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
| | - Alicia Sánchez-García
- Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, 03550 Sant Joan d’Alacant, Spain; (P.B.); (E.G.-H.); (A.S.-G.)
| | - María Asunción Vicente Ripoll
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
| | | | - Pastora Pérez-Pérez
- Unidad Territorial II. Provincia San Juan de Dios de España, 41005 Sevilla, Spain;
| | - Mercedes Guilabert Mora
- Departamento Psicología de la Salud, Universidad Miguel Hernández, 03202 Elche, Spain; (V.P.-J.); (I.C.M.); (C.F.P.); (M.A.V.R.); (M.G.M.)
- Health District Alicante-Sant Joan, 03013 Alicante, Spain
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Pomales-Ramos A, Tokish H, Howard M, Straiton D, Ingersoll B. A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis. Front Psychol 2023; 14:1173644. [PMID: 37546433 PMCID: PMC10399227 DOI: 10.3389/fpsyg.2023.1173644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023] Open
Abstract
Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.
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13
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Cheung WC, Ostrosky MM. Supporting Preschoolers' Motor Development in Virtual Environments: Listening to Teachers' Voices. EARLY CHILDHOOD EDUCATION JOURNAL 2023:1-10. [PMID: 37360591 PMCID: PMC10111320 DOI: 10.1007/s10643-023-01492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 06/28/2023]
Abstract
Going down a slide, dancing to music, and pushing someone on a tire swing are more than simply "play activities" or a means to staying physically fit. Engagement in motor play provides important opportunities for preschoolers to develop a variety of skills, including gross motor, social, communication, and cognitive skills. However, during the past several years, since the identification of the COVID-19 virus, no guidelines have been available to ensure that gross motor content is addressed while simultaneously meeting the educational needs of preschoolers with and without disabilities during virtual learning. The purpose of this study was to understand the benefits and challenges that 26 preschool teachers faced as they attempted to embed motor play into their curriculum during virtual learning. All teachers worked in inclusive preschool settings and interviews were conducted between March-June 2021. Constant comparative analysis and emergent coding were used to interpret the data. Findings revealed that school readiness skills were the primary focus of virtual learning. Teachers indicated that motor play can help expand students' pre-academic skills, be fun and motivating for children, and help students be more focused and attentive. Some logistical barriers (e.g., technology, limited physical spaces, limited resources) need to be addressed in order to successfully teach motor play in a virtual format. Study findings suggest policies and guidelines need to be established to provide young children with high quality and accessible virtual instruction. Implications for research and practice are discussed. Supplementary Information The online version contains supplementary material available at 10.1007/s10643-023-01492-w.
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Affiliation(s)
- W. Catherine Cheung
- Department of Special Education, University of Illinois Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - Michaelene M. Ostrosky
- Department of Special Education, University of Illinois Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
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14
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Hinton V, Akemoğlu Y, Tomeny K, McWilliam RA. Supporting Families from a Distance: Implementing Routines-Based Home Visits via Telepractice. EARLY CHILDHOOD EDUCATION JOURNAL 2023:1-8. [PMID: 37360610 PMCID: PMC10021040 DOI: 10.1007/s10643-023-01464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 06/28/2023]
Abstract
Early intervention is a system of services designed to strengthen child outcomes and build family capacity. One approach of service provision is the Routines-Based Model which implements adult-learning practices wherein service providers and caregivers partner to build family-mediated interventions for children. Owing to COVID-19 and the benefits of telepractice, more and more service providers are likely to incorporate a telepractice modality into service provision. Because the Routines-Based Model uses family consultation, these home-visiting practices translate well to telepractice. In addition to consultation techniques, however, service providers must use technology advantageously to ensure effective communication practices. This article discusses technology uses in telepractice that can be incorporated in the Routines-Based Model, Tele-Routines-Based Home Visits, and examples of Tele-Routines-Based Home Visits.
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Affiliation(s)
- Vanessa Hinton
- Department of Special Education, Rehabilitation, and Counseling, Auburn University, 2084 Haley Center, Auburn, AL 36849 USA
| | - Yusuf Akemoğlu
- Department of Special Education, Düzce University, Konuralp, 81000 Düzce, Turkey
| | - Kimberly Tomeny
- Department of Special Education and Multiple Abilities, The University of Alabama, 902 University Blvd Graves 201, Box 870232, Tuscaloosa, AL 35487 USA
| | - Robin A. McWilliam
- Department of Special Education and Multiple Abilities, The University of Alabama, 902 University Blvd Graves 201, Box 870232, Tuscaloosa, AL 35487 USA
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15
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Carroll R, Halbur M, Preas E. Developing and Delivering Behavioral Interventions Through Telehealth. Behav Modif 2023; 47:291-296. [PMID: 36738177 DOI: 10.1177/01454455231153784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This special issue on telehealth in Behavior Modification features 10 studies related to developing and delivering behavioral interventions through telehealth. The studies in this issue cover a variety of topics including using telehealth to train caregivers, training clinicians to use telehealth, and directly implementing interventions or assessments through telehealth. The special issue concludes with a comprehensive literature review examining variables that impact the effectiveness of telehealth as a service-delivery tool.
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Affiliation(s)
- Regina Carroll
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Mary Halbur
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
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16
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Caregiver and Clinician Experience With Virtual Services for Children and Youth With Complex Needs During COVID-19. J Pediatr Health Care 2023; 37:167-172. [PMID: 36307282 PMCID: PMC9534789 DOI: 10.1016/j.pedhc.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, support services for children and youth quickly shifted to virtual means. To continue delivering essential, trauma-informed, specialized services, the center transitioned to providing most services by phone/video conference. METHOD A quality improvement project using survey methods was conducted to determine if virtual delivery was timely and satisfactory for inpatient and outpatient care. RESULTS Findings indicated services were timely. Caregivers appreciated the support, felt a personal connection with staff, and confirmed services met their goals and expectations. However, challenges faced by staff included engaging the child/youth by phone/video, loss of collaboration with colleagues, and concerns about fulfilling their role through virtual means. DISCUSSION Understanding stakeholder experiences illuminated the path of quality improvement during this major shift in service delivery. Benefits were shown for a blended model of in-person and virtual services on the basis of clinical judgment and the unique needs of clients and families in considering future service model options.
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17
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Preas E, Carroll RA, Van Den Elzen G, Halbur M, Harper M. Evaluating the Use of Video Modeling With Voiceover Instructions to Train Therapists to Deliver Caregiver Training Through Telehealth. Behav Modif 2023; 47:402-431. [PMID: 35850543 DOI: 10.1177/01454455221111988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Caregiver training is an important component of behavioral intervention; however, many barriers exist for in-person training. Alternatively, behavioral therapists may use telehealth as a service delivery method. To effectively train caregivers through telehealth, therapists should receive explicit training, but there has been limited research on effective methods for teaching this skill. The purpose of the current study was to evaluate video modeling with voice-over instruction (VMVO) to train therapists to implement 11 component skills of caregiver training through telehealth to teach confederate caregivers to implement a guided compliance procedure. We measured the therapist's implementation of the component skills during a scripted role-play before and after video-model training within a multiple baseline design across participants. We also conducted maintenance and generalization probes to a novel skill. All seven therapists learned the skill, but three therapists required a feedback component in addition to the VMVO. The results suggest that VMVO may be an efficient and effective method for training therapists to conduct caregiver training via telehealth. Furthermore, results indicate that component skill analyses may be valuable to monitor skills that require remediation.
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Affiliation(s)
- Elizabeth Preas
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Regina A Carroll
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | | | - Mary Halbur
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Megan Harper
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
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18
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Larsen A, Schieltz KM, Barrett A, O'Brien MJ. A Retrospective Analysis of Therapists' Coaching Behavior When Directing Parents to Conduct Behavioral Assessments and Treatments Via Telehealth. Behav Modif 2023; 47:154-184. [PMID: 35730524 PMCID: PMC11019754 DOI: 10.1177/01454455221106127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on the delivery of behavioral assessment and treatment via telehealth has focused largely on child outcomes and parent procedural fidelity. By contrast, the behavior of the therapists coaching parents to conduct assessment and treatment has garnered little research consideration. In this study, we conducted a retrospective analysis of behavior therapists' coaching behaviors when directing parents to conduct functional analysis (FA) and functional communication training (FCT) with their young children with autism via telehealth. Coaching behaviors for five experienced behavior therapists across seven parent-child dyads were scored using a combination of standardized and novel behavior codes. Therapists displayed more social engagement behaviors than any other type of behavior throughout the study, and rates of antecedent and consequence behaviors shifted across the FA and FCT phases. Results are discussed in relation to therapists' goals during behavioral assessment and treatment and the implications for training behavioral therapists to coach parents via telehealth.
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19
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Coon JC, Bush H, Rapp JT. Eight Months of Telehealth for a State-Funded Project in Foster Care and Related Services: Progress Made and Lessons Learned. Behav Anal Pract 2022; 15:1348-1360. [PMID: 35313702 PMCID: PMC8924942 DOI: 10.1007/s40617-022-00682-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
In response to the COVID-19 pandemic, many behavior analysts and other health professionals modified their services for delivery via telehealth modalities. The transition to telehealth is especially important for providers working with foster youth who exhibit challenging behavior because these youth often move to another placement due to such behaviors. The primary objective of this article was to evaluate the extent to which service indicators for a state-funded team working with foster youth changed after the service delivery model changed from in-person to telehealth services. In particular, we evaluated changes in monthly count of client contacts, appointments, intakes, closed cases, and medication reviews. The secondary objective was to outline potential benefits and environmental barriers encountered by the team and to integrate our findings with the literature on behavior-analytic services provided via telehealth. Overall, results show that we maintained service quality with a broad range of behavioral interventions and increased overall client appointments. Given these outcomes, our team may continue to provide behavioral services via telehealth after the COVID-19 pandemic.
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Affiliation(s)
- Jodi C. Coon
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
| | - Helena Bush
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
| | - John T. Rapp
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
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20
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Kiyak UE, Toper O. Teaching Science Facts to Students with Autism Spectrum Disorders via Telehealth. JOURNAL OF BEHAVIORAL EDUCATION 2022; 32:1-11. [PMID: 36408366 PMCID: PMC9643931 DOI: 10.1007/s10864-022-09497-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
The interruption in the education of students with autism spectrum disorders (ASD) during the COVID-19 pandemic has necessitated telehealth services offered both to the individuals and their parents. Therefore, this study aimed to examine the effects of the simultaneous prompting procedure and observational learning in teaching science facts to middle-school students with ASD by using multiple probe designs with probe trials via telehealth. The researchers also conducted follow-up and novel adult probe sessions to assess the effects of simultaneous prompting procedure and observational learning along with the opinions of students and their mothers in terms of social validity. Results indicated that students acquired the target science facts and observational learning skills, maintained them over time, and generalized them across different people. The implication of the findings and directions for future research was additionally discussed.
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Affiliation(s)
| | - Ozlem Toper
- Department of Special Education, Bursa Uludag University, Bursa, Turkey
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21
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Togashi K, Minagawa Y, Hata M, Yamamoto J. Evaluation of a Telehealth Parent-Training Program in Japan: Collaboration with Parents to Teach Novel Mand Skills to Children Diagnosed with Autism Spectrum Disorder. Behav Anal Pract 2022; 16:1-12. [PMID: 36313232 PMCID: PMC9591318 DOI: 10.1007/s40617-022-00752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
This study developed a telehealth parent-training program to teach parents of children with autism spectrum disorder the process of mand-training implementation in Japan, and to further the international dissemination of evidence-based training strategies. Parent-training sessions were based on a behavioral skills training (BST) model, combined with weekly graphic and video feedback. The sessions were conducted by a board-certified behavior analyst-doctoral residing in Japan. Four parents with children with autism spectrum disorder participated in this study. The results preliminarily support the effectiveness and social validity of the program. This study extends previous parent-training research conducted in Japan by comprising all of the following features: (1) online program design; (2) mand training; (3) BST model; (4) session-by-session data on children's behavioral changes and procedural integrity; (5) within-subject experimental design; and (6) social validity evaluation.
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Affiliation(s)
- Kohei Togashi
- Global Research Institute, Keio University, Minato City, Tokyo Japan
- Present Address: Behavior Solutions, KS Floor, 5F Resona-Kudan Bldg, 1-5-6 Kudan-Minami, Chiyoda, Tokyo 102-0074 Japan
| | - Yasuyo Minagawa
- Faculty of Letters, Keio University, Minato City, Tokyo Japan
| | - Masahiro Hata
- Global Research Institute, Keio University, Minato City, Tokyo Japan
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22
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MacNaul H, Wimberley J, Labay A, Neely L, Novotny M, Morgan B. Effects of an Adapted Telehealth Training Curriculum for Registered Behavior Technicians®. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 7:1-12. [PMID: 36160310 PMCID: PMC9483257 DOI: 10.1007/s41252-022-00285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Objectives We evaluated a telehealth training curriculum to prepare Registered Behavior Technicians® (RBTs®) to conduct caregiver coaching on behavior analytic skills via telehealth. Methods A non-concurrent multiple baseline across therapists design was used to evaluate the training procedures delivered by Board Certified Behavior Analysts® (BCBAs®). All therapists (RBTs) worked with one family during the baseline and training phases and an additional session was conducted with a different family during the novelty probe condition to see if therapists were able to perform the newly acquired skills without BCBA support. Results Seven therapists who received behavioral skills training on the curriculum reached mastery criteria within three sessions. All RBTs were able to provide caregiver coaching via telehealth with high degrees of fidelity and were able to independently conduct a telehealth session with a new family without support from the BCBA. Conclusions Results of the current study provide support for the use of the telehealth training curriculum to prepare RBTs to conduct ABA services via telehealth.
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Affiliation(s)
- Hannah MacNaul
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
| | | | | | - Leslie Neely
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
| | - Marissa Novotny
- Department of Educational Psychology, University of Texas at San Antonio, San Antonio, TX USA
- Autism Treatment Center, San Antonio, TX USA
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23
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Akers JS, Davis TN, McGinnis K, Swensson RM. Effectiveness of Remote Delayed Performance Feedback on Accurate Implementation of Caregiver Coaching. JOURNAL OF BEHAVIORAL EDUCATION 2022; 33:1-24. [PMID: 35971548 PMCID: PMC9365676 DOI: 10.1007/s10864-022-09487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
The supervision of field experiences is an indispensable component of Board-Certified Behavior Analyst (BCBA®) training. During the supervised field experience, supervisors regularly provide performance feedback to trainees for the purpose of improving fidelity of implementation of various assessments and interventions. Emerging evidence supports the efficacy of using telehealth to train teachers and parents to implement interventions, but no study has evaluated the effectiveness of the remote delayed performance feedback among individuals completing BCBA® training. We used videoconference equipment and software to deliver remote delayed performance feedback to seven participants enrolled in a graduate program and completing supervised field experience. Remote delayed performance feedback was provided regarding participants' implementation of caregiver coaching. The results indicate that delayed performance feedback provided remotely increased the correct implementation of caregiver coaching. These preliminary results indicate the efficacy of remote supervision and delayed performance feedback.
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Affiliation(s)
- Jessica S. Akers
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Tonya N. Davis
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Kristina McGinnis
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
| | - Remington M. Swensson
- Department of Educational Psychology, Baylor University, One Bear Place #97301, Waco, TX 76798 USA
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24
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Craig EA, Dounavi K, Ferguson J. Effectiveness of a Brief Functional Analysis and Functional Communication Training Conducted Through Telehealth. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:227-246. [PMID: 35967272 PMCID: PMC9358095 DOI: 10.1007/s10882-022-09857-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 05/13/2023]
Abstract
This study evaluates the effectiveness of a brief functional analysis and functional communication training conducted via telehealth. Three interventionist-child dyads took part in the study including one speech and language pathologist and two school teaching assistants, each working with one child with autism spectrum disorder. Interventionists were trained using didactic training to implement a brief functional analysis as well as synchronous coaching from a BCBA® to implement functional communication training. A multiple baseline across participants design was utilised to evaluate if interventionists could implement functional communication training to decrease challenging behaviours that included aggression, elopement and disruption. Sessions concluded earlier than planned due to school closures mandated by the COVID-19 outbreak for two of the three participants; however, existing data provide evidence that telehealth is a valid model for enabling clinicians to work in collaboration with school personnel to effectively deliver assessment and intervention procedures remotely via telehealth.
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Affiliation(s)
- Emma A. Craig
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Katerina Dounavi
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Jenny Ferguson
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
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25
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Cheung WC, Aleman-Tovar J, Johnston AN, Little LM, Burke MM. A Qualitative Study Exploring Parental Perceptions of Telehealth in Early Intervention. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2022; 35:353-373. [PMID: 35789590 PMCID: PMC9244129 DOI: 10.1007/s10882-022-09853-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
UNLABELLED Using telehealth as a mode of service delivery has the potential to address some long-standing challenges in early intervention (EI) services such as waiting lists to access services. Yet, little is known about parent perceptions of telehealth in EI based on their lived experiences partnering with EI practitioners. The purpose of this study was to explore parent perceptions on using telehealth, especially on family-professional partnerships and coaching. Interviews were conducted with 15 parents of children receiving EI services via telehealth from June to August of 2021. Almost half of the participants reflected under-represented racial and ethnic backgrounds. Constant comparative analysis and emergent coding were used for data analysis. The findings showed that the advantages outnumbered the disadvantages regarding telehealth. Participants reported that telehealth provided a safe and flexible option and eliminated the wait to access EI services. However, participants identified some disadvantages to telehealth including telehealth precluded substantive interactions with therapists and limited access to technology. The findings also indicated that telehealth enhanced family-professional partnerships. Nearly all participants valued coaching during telehealth. Participants suggested initial supports to facilitate EI via telehealth, including stable internet access, telehealth training, and an initial in-person visit. Implications for research and practice are discussed. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10882-022-09853-w.
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Affiliation(s)
- W. C. Cheung
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - J. Aleman-Tovar
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - A. N. Johnston
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
| | - L. M. Little
- Rush University, 600 S. Paulina St, Chicago, IL 1009A AAC60612 USA
| | - M. M. Burke
- University of Illinois at Urbana-Champaign, 288 Education, 1310 South Sixth Street, Champaign, IL 61820 USA
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26
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Ruppel PR, Juanico JF, Johnson KLD. The Effects of Remote Instructions, Rehearsal, and Feedback on Preference Assessment Implementation. JOURNAL OF ORGANIZATIONAL BEHAVIOR MANAGEMENT 2022. [DOI: 10.1080/01608061.2022.2078455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paula R. Ruppel
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
| | - Jessica F. Juanico
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
| | - Kayt-Lyn D. Johnson
- University of Kansas, Department of Applied Behavioral Science, Lawrence, Kansas, USA
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27
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King HC, Wu S, Bloomfield BS, Fischer AJ, Martone LE. A Practical Guide on Problem-Solving Teleconsultation in Schools. JOURNAL OF EDUCATIONAL AND PSYCHOLOGICAL CONSULTATION 2022. [DOI: 10.1080/10474412.2022.2070495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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28
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Lord Ferguson S, Smith C, Kietzmann J. Hands-off? Lessons from high-touch professionals about going virtual. BUSINESS HORIZONS 2022; 65:303-313. [PMID: 35132278 PMCID: PMC8810297 DOI: 10.1016/j.bushor.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The COVID-19 crisis has fundamentally changed how many businesses operate and connect with their customers. Previously unheard-of government restrictions and sheltering-in-place requirements forced most professional services to transition to remote delivery methods (e.g., email, telephone, video consults, Shopify storefronts). Providers of low-touch services (e.g., lawyers, accountants) naturally lent themselves to remote delivery; however, those that offer high-touch services, particularly those in healthcare (e.g., doctors, chiropractors, physical therapists), experienced a drastic change in working conditions when going virtual. Despite a long history of resistance to virtual delivery, the pandemic created an unprecedented incentive for these high-touch professionals to experiment with underutilized care models such as telehealth: the provision of healthcare services remotely using telecommunications technologies. We examine the rapid adoption of telehealth during COVID-19 through the coming together or convergence of previously unrelated technologies, spaces, and practices. Our analysis reveals opportunities and challenges associated with going hands-off that apply to many other professionals providing high-trust services. Specifically, we offer nine guiding principles for building and protecting cognitive and affective trust in virtual and hybrid delivery models. This is important given the pace of compounding technology convergences that lie ahead for service professionals.
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Affiliation(s)
| | - Claudia Smith
- Gustavson School of Business, University of Victoria, Canada
| | - Jan Kietzmann
- Gustavson School of Business, University of Victoria, Canada
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29
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Araiba S, Čolić M. Preliminary Practice Recommendations for Telehealth Direct Applied Behavior Analysis Services with Children with Autism. JOURNAL OF BEHAVIORAL EDUCATION 2022; 32:1-35. [PMID: 35464786 PMCID: PMC9013273 DOI: 10.1007/s10864-022-09473-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
This article provides preliminary practice recommendations for telehealth direct applied behavior analysis (ABA) services for children with autism. In the face of COVID-19, there is an immediate need for discussion on how to implement various ABA procedures via telehealth for ABA practitioners. Alongside emerging scientific evidence on the effectiveness of telehealth direct service as well as various service-related guidelines, we provide preliminary practice recommendations that are based on the existing literature on in-person and telehealth ABA procedures. We also discuss these recommendations with case studies of two boys with autism. Social validity measures indicated that families were satisfied with telehealth direct services. Even after the COVID-19 pandemic has resolved itself, telehealth direct ABA service will still be a valuable option for remote and international locations where direct ABA service is limited, and thus, practice recommendations continue to be relevant for all practitioners that use telehealth direct service.
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Affiliation(s)
- Sho Araiba
- Positive Behavior Support Corporation, 1645 Ala Wai Blvd., Honolulu, HI 96815 USA
| | - Marija Čolić
- Special Education Department, University of Hawai’i at Manoa, Honolulu, HI USA
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Vanegas SB, Dueñas AD, Kunze M, Xu Y. Adapting
parent‐focused
interventions for diverse caregivers of children with intellectual and developmental disabilities: Lessons learned during global crises. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2022. [DOI: 10.1111/jppi.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ana D. Dueñas
- College of Education and Human Services Lehigh University Bethlehem Pennsylvania USA
| | - Megan Kunze
- Department of Special Education and Clinical Sciences and Center for Brain Injury Research and Training University of Oregon Eugene Oregon USA
| | - Yue Xu
- Department of Health Sciences Education University of Illinois College of Medicine at Rockford Rockford Illinois USA
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Neely L, Tsami L, Graber J, Lerman DC. Towards the development of a curriculum to train behavior analysts to provide services via telehealth. J Appl Behav Anal 2022; 55:395-411. [PMID: 35099076 DOI: 10.1002/jaba.904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has led to a dramatic increase in behavior analysts' use of telehealth services. Nonetheless, no research has evaluated the skills or training needed for therapists to provide these services effectively. The purpose of this study was to develop and evaluate a curriculum for providing high-quality, parent-training telehealth services. Four in-service Board Certified Behavior Analysts® (BCBAs®) who received brief behavioral skills training on this curriculum reached 100% fidelity within four sessions. The skills generalized to a novel family and maintained nearly 1 year after the training. All participants rated the training as highly acceptable and effective. The independent ratings of 4 in-service BCBAs, blinded to the study conditions, also supported the social validity of the outcomes. This curriculum may be considered an initial step towards development of competency for interventionists providing ABA services via telehealth. Further research is warranted as demand for telehealth services continues to grow.
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Lee JD, Hacker RE, Meadan H, Haidar BS. Challenging Behaviors Online Modules for Parents of Young Children with Disabilities: A Pilot Feasibility Study. EDUCATION & TREATMENT OF CHILDREN 2022; 45:341-355. [PMID: 35002056 PMCID: PMC8720550 DOI: 10.1007/s43494-021-00067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
Challenging behaviors exhibited by young children negatively affect development and may also prevent children from receiving appropriate education. These behaviors may also hinder positive family interactions and have a significant impact on parents and other family members. Although various parent training approaches exist to increase parents' capacity to address these challenging behaviors, many parents are reportedly not able to access training due to time and resource constraints. To address inequitable dissemination of information, we developed and piloted the use of the Challenging Behavior Online Modules with 10 parents of children with disabilities. In particular, we examined the feasibility of the Challenging Behavior Online Modules for increasing parents' knowledge and use of positive parenting practices with their young children. Parents reported satisfaction with the contents and delivery method of the intervention. Implications and directions for future research are also suggested.
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Affiliation(s)
- James D. Lee
- Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Avenue, Kansas City, KS 66101 USA
| | - Rebecca E. Hacker
- Juniper Gardens Children’s Project, University of Kansas, 444 Minnesota Avenue, Kansas City, KS 66101 USA
| | - Hedda Meadan
- Department of Special Education, University of Illinois at Urbana-Champaign, Champaign, IL USA
| | - Ban Sleiman Haidar
- Department of Special Education, University of Illinois at Urbana-Champaign, Champaign, IL USA
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33
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Maguire H, Harper JM, Gardner RM, Luiselli JK. Behavioral Training and Performance Management of Human Services Organization Care Providers During the COVID-19 Pandemic. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:340-348. [PMID: 35005217 PMCID: PMC8723703 DOI: 10.1007/s41252-021-00234-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/13/2023]
Abstract
Objectives This report describes a model of training and performance management that was designed for and implemented with care providers at a residential school for children with neurodevelopmental and intellectual disabilities in response to the COVID-19 pandemic. The model focused on health and safety concerns, risk mitigation, and intervention integrity. Methods Procedures followed an applied behavior analysis (ABA) and organizational behavior management (OBM) framework. Action plans addressed (a) critical COVID-19 protocols, (b) behavior-specific implementation guidelines, (c) remote and in-person training formats, (d) in vivo supervision, and (e) knowledge and performance assessments. Results A competency evaluation (field study) revealed that participant care providers (N = 25) acquired and maintained COVID-19 protocols at near 100% proficiency immediately following and 1-month post-training. Supervisors had uniformly positive approval and acceptance ratings of school responsiveness to the COVID-19 pandemic. Conclusions Integrated and evidence-based care provider training and supervisory practices can promote risk mitigation and performance effectiveness during health crises such as the COVID-19 pandemic. More controlled research that includes multiple dependent measures is needed to replicate and extend our findings to similar human services settings.
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Affiliation(s)
- Helena Maguire
- Clinical Development and Research, Melmark New England, 461 River Road, Andover, MA 01801 USA
| | - Jill M Harper
- Clinical Development and Research, Melmark New England, 461 River Road, Andover, MA 01801 USA
| | | | - James K Luiselli
- Clinical Development and Research, Melmark New England, 461 River Road, Andover, MA 01801 USA
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34
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Srinivasan R, Wallis KE, Soares N. Global Trends in Telehealth Among Clinicians in Developmental-Behavioral Pediatric Practice: A COVID-19 Snapshot. J Dev Behav Pediatr 2022; 43:32-37. [PMID: 33990511 DOI: 10.1097/dbp.0000000000000963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to describe the extent of telehealth use by global developmental-behavioral pediatrics (DBP) clinicians and barriers (if any) in adopting telehealth during the coronavirus disease 2019 (COVID-19) pandemic. METHODS A survey was disseminated to DBP clinicians through contact with international professional organizations to determine the use of telehealth in DBP care, before and since the beginning of the COVID-19 pandemic. Descriptive statistics and χ2 tests were used for analysis. RESULTS A total of 271 respondents from 38 countries completed the survey. The number of respondents offering telehealth increased from 36% to 88% after the pandemic, with the greatest shift to telehealth among high-income countries (HICs). Among respondents using telehealth, 75.1% were conducting interactive video visits, with HICs using more telehealth modalities embedded in electronic health records. Most patients (98.7%) were at home for the telehealth encounter. Almost half (46.5%) could not include an interpreter in telehealth visits. Barriers reported by telehealth users included concerns about limited patient access to technology (74.3%), home environment distractions (56.5%), preference for in-person care (53.6%), telehealth effectiveness (48.1%), workflow efficiency (42.2%), and cost/reimbursement (32.1%). CONCLUSION Global DBP clinicians rapidly adopted telehealth and continued to have interprofessional practice while doing so, with the largest adoption occurring in HICs. Provider concerns about effectiveness and patient access to technology emerged as key organizational and patient barriers, respectively. Increased provider confidence in telehealth and its sustained use in the future depends on supportive regulatory policies and availability and use of measures to monitor quality and effectiveness.
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Affiliation(s)
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Neelkamal Soares
- Division of Developmental-Behavioral Pediatrics, Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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35
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Awasthi S, Aravamudhan S, Jagdish A, Joshi B, Mukherjee P, Kalkivaya R, Ali RS, Srivastava SN, Edasserykkudy S. Transitioning ABA Services From in Clinic to Telehealth: Case Study of an Indian Organization's Response to COVID-19 Lockdown. Behav Anal Pract 2021; 14:893-912. [PMID: 34394851 PMCID: PMC8356690 DOI: 10.1007/s40617-021-00600-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Due to the coronavirus (COVID-19) pandemic, around the middle of March 2020, in-clinic intervention services based in applied behavior analysis provided to children had to be stopped abruptly in India. This qualitative and quantitative case study details how Behavior Momentum India (BMI), an organisation providing ABA-based interventions, transitioned services from in clinic to telehealth while continuing to target each student's skill acquisition goals in language and communication domains. A cohort of 92 students diagnosed with autism or other learning disabilities participated in this study; 51 therapists, 9 behavior supervisors, and a doctoral-level Board Certified Behavior Analyst collaborated with parents; 78% of the students and 82% of the therapists used smartphones; and only a few used iPads and laptops. Therapists conducted direct sessions and parent-mediated sessions with 82 students. With 10 students, behavior supervisors trained parents to implement interventions with their children. The critical transition decisions, logistics, and ethical challenges were identified using qualitative methods. Despite significantly reduced session durations, all students continued to acquire targeted skills, and 52% of the students acquired more skills in telehealth compared to in clinic. A parent satisfaction survey returned high ratings onour organization's initiative, and 72% of the parents reported that their familiarity and confidence with the science of applied behavior analysis had increased.
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Affiliation(s)
- Smita Awasthi
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Sridhar Aravamudhan
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Anupama Jagdish
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Bhavana Joshi
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Papiya Mukherjee
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Rajeshwari Kalkivaya
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Razia Shahzad Ali
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | | | - Sreemon Edasserykkudy
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
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36
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Bergmann S, Toussaint KA, Niland H, Sansing EM, Armshaw G, Baltazar M. Adapting Direct Services for Telehealth: A Practical Tutorial. Behav Anal Pract 2021; 14:1010-1046. [PMID: 34659652 PMCID: PMC8509939 DOI: 10.1007/s40617-020-00529-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
Due to the pandemic brought on by the novel coronavirus (COVID-19), consumers of applied behavior-analytic interventions may be experiencing disrupted access to services. In response to the need for services, behavior analysts and therapists may find themselves treading unchartered waters as they use telehealth to provide direct intervention to consumers. Direct service provision via telehealth extends beyond the bounds of existing telehealth research, which primarily focuses on caregiver training and consultation. In the transition to telehealth, behavior analysts can consider how to adapt an existing evidence base of behavior-analytic strategies from a face-to-face format to intervention via a teleconferencing platform (i.e., Zoom). In this tutorial, we provide practice recommendations, task analyses, and a curated list of Zoom walk-throughs to help behavior analysts construct conceptually systematic learning opportunities in their direct telehealth services. Leveraging teleconferencing features to provide behavior-analytic intervention directly to consumers could spur future research to support these need-inspired practices and guide telehealth applications during and beyond the current pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-020-00529-5.
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Affiliation(s)
- Samantha Bergmann
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
| | - Karen A. Toussaint
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
| | - Haven Niland
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
- UNT Kristin Farmer Autism Center, University of North Texas, Denton, TX USA
| | - Elizabeth M. Sansing
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
- UNT Kristin Farmer Autism Center, University of North Texas, Denton, TX USA
| | - Gabriel Armshaw
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
- UNT Kristin Farmer Autism Center, University of North Texas, Denton, TX USA
| | - Marla Baltazar
- Department of Behavior Analysis, University of North Texas, 1155 Union Circle #310919, Denton, TX 76203 USA
- UNT Kristin Farmer Autism Center, University of North Texas, Denton, TX USA
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Ninci J, Čolić M, Hogan A, Taylor G, Bristol R, Burris J. Maintaining Effective Supervision Systems for Trainees Pursuing a Behavior Analyst Certification Board Certification During the COVID-19 Pandemic. Behav Anal Pract 2021; 14:1047-1057. [PMID: 33995855 PMCID: PMC8112215 DOI: 10.1007/s40617-021-00565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 01/11/2023] Open
Abstract
Behavior analysts acting as supervisors of individuals pursuing Behavior Analyst Certification Board certification are tasked with designing effective and ethical supervision and training systems. Behavior analyst supervisors and their trainees may face challenges fulfilling their responsibilities in the midst of barriers that include competing contingencies, transitions, and interruptions. In this article, we review potential obstacles faced by supervisors in designing effective supervision through site closures and transitions to telepractice as a result of the COVID-19 pandemic. We explore related potential barriers faced by trainees serving clients through public school settings, as well as through insurance-funded agencies in the United States. We review some practical solutions and offer tools for supervisors and trainees to consider at this time. We present a template for trainees to help them develop a personalized applied behavior analysis fieldwork plan for their supervision, a client/family needs assessment, and a corresponding trainee needs assessment to assist with adaptations to supervision and service delivery in an individualized manner.
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Affiliation(s)
- Jennifer Ninci
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Marija Čolić
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Ashley Hogan
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Gregory Taylor
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Roxanne Bristol
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
| | - Jessica Burris
- Department of Special Education, University of Hawai‘i at Mānoa, 1776 University Ave., Honolulu, HI 96822 USA
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38
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Andrews ML, Garcia YA, Catagnus RM, Gould ER. Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents' autistic children's behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents' ratings of their children's challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children's behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Affiliation(s)
- Meredith L. Andrews
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
| | | | - Robyn M. Catagnus
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
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39
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Johnsson G, Bulkeley K. Practitioner and Service User Perspectives on the Rapid Shift to Teletherapy for Individuals on the Autism Spectrum as a Result of COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11812. [PMID: 34831567 PMCID: PMC8620428 DOI: 10.3390/ijerph182211812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Prior to COVID-19, research into teletherapy models for individuals on the autism spectrum was slowly progressing. Following the onset of COVID-19, teletherapy became a necessity for continuity of services, however, research was still emerging for how to translate best practice autism support to the online environment. The aim of this research was to gain insight into the rapid shift to teletherapy for practitioner and service users and the implications for the broader disability sector. Survey responses were collected from 141 allied health practitioners (speech pathologists, occupational therapists, psychologists, educators, and social workers) from four Australian states and territories. A total of 806 responses were collected from service users following an individual teletherapy session. Five themes were identified during the qualitative analysis; (1) technology-love it or hate it; (2) teletherapy as a "new normal"; (3) short term pain, for long term gain; (4) the shape of service delivery has changed; (5) is teletherapy always an option? Data from the quantitative analysis provided further insights into the first two themes. While COVID-19 has brought forward significant advances in telehealth models of practice, what is needed now is to delve further into what works, for who, and in which context, and explore the potentiality, efficiencies, and scalability of a post-pandemic hybrid approach. This will inform practice guidelines and training, as well as information for service users on what to expect.
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Affiliation(s)
- Genevieve Johnsson
- Individual and Community Services, Autism Spectrum Australia, Sydney 2153, Australia
- Centre for Disability Research and Policy, University of Sydney, Sydney 2153, Australia;
| | - Kim Bulkeley
- Centre for Disability Research and Policy, University of Sydney, Sydney 2153, Australia;
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40
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O'Brien MJ, Pelzel KE, Hendrix NM, Schieltz KM, Miller K, Call NA, Tsami L, Lerman DC, Berg WK, Kopelman TG, Wacker DP, Lindgren SD. Parent Ratings of Generalized and Indirect Effects of Functional Communication Training for Children with Autism Spectrum Disorder. Behav Modif 2021; 46:971-1001. [PMID: 34041956 DOI: 10.1177/01454455211018815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Functional communication training (FCT) is a behavioral treatment that has been shown to reduce problem behavior and increase appropriate communication in young children with autism spectrum disorder (ASD). In this study, we assessed the effects of FCT on targeted and nontargeted problem behaviors outside of the training context, as well as parent stress, for 30 young children with ASD and their parents. Indirect measures of generalization treatment effects were administered prior to and following FCT treatment delivered via telehealth. Children demonstrated significant improvement on both targeted (measured via observation) and nontargeted (measured via checklist) problem behaviors, both within and outside of the training context, and parent stress was significantly reduced following treatment. These results suggest that the impact of FCT may extend beyond the training context for both the children being treated and the parents delivering treatment, even when generalization is not specifically programmed for during treatment.
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Affiliation(s)
- Matthew J O'Brien
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Kelly E Pelzel
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Nicole M Hendrix
- Marcus Autism Center, Atlanta, GA, USA.,Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Kelly M Schieltz
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Kenzie Miller
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Nathan A Call
- Marcus Autism Center, Atlanta, GA, USA.,Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
| | - Loukia Tsami
- The University of Houston - Clear Lake, Houston, TX, USA
| | | | - Wendy K Berg
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Todd G Kopelman
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - David P Wacker
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - Scott D Lindgren
- The University of Iowa, Iowa City, IA, USA.,The University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
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41
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A Craig E, Dounavi K, Ferguson J. Telehealth to train interventionists teaching functional living skills to children with autism spectrum disorder. J Appl Behav Anal 2021; 54:511-529. [PMID: 33829493 DOI: 10.1002/jaba.834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 11/11/2022]
Abstract
The number of Board Certified Behavior Analysts® (BCBA®s) available outside of the United States is significantly lower than the number of individuals with a diagnosis of autism spectrum disorder (ASD) requiring services. Research on alternative delivery platforms, such as telehealth, to disseminate interventions to those in need is of paramount importance. The current study evaluated the effectiveness of training professionals working with individuals with ASD in behavior-analytic procedures through telehealth. Four professional-child dyads took part. Data were collected on the professionals' treatment fidelity and number of independent steps performed by the children for 3 functional daily living skills. The study employed a multiple probe design across participants and included a cost analysis. All 4 professionals met the mastery criterion and all 4 children demonstrated increases in independence.
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Affiliation(s)
- Emma A Craig
- School of Social Sciences, Education & Social Work, Queen's University of Belfast
| | - Katerina Dounavi
- School of Social Sciences, Education & Social Work, Queen's University of Belfast
| | - Jenny Ferguson
- School of Social Sciences, Education & Social Work, Queen's University of Belfast
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42
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Oblak MK. An analysis of a system under pandemic conditions. J Appl Behav Anal 2021; 54:530-546. [PMID: 33817789 DOI: 10.1002/jaba.836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/05/2023]
Abstract
Recent events have emphasized the need for behavior-analytic service delivery models that can remain clinically consistent and produce high-quality outcomes while adapting to environmental change. This paper reports outcomes of an organization that adapted to changes in its service delivery model during a worldwide pandemic. The organization utilized components from the Comprehensive Application of Behavior Analysis to Schooling (CABAS®) model. The components were interconnected within the system and linked by specific interlocking contingencies. Performance data were used to make decisions within the organization on both individual and organizational levels during the transition to telehealth for clients and staff. Results are discussed in terms of how the interconnectedness of components within the organization contributed to the reliable, positive outcomes of the system during the transition to telehealth.
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43
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Leyser M, Schieltz K, Strathearn L, Cooper-Brown L, McBrien D, O'Brien M. Telehealth in the Field of Developmental-Behavioral Pediatrics: Advantages, Challenges, and Future Perspectives. J Dev Behav Pediatr 2021; 42:240-244. [PMID: 33759849 DOI: 10.1097/dbp.0000000000000920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 12/01/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Marcio Leyser
- Division of Developmental and Behavioral Pediatrics, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
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Shawler LA, Clayborne JC, Nasca B, O'Connor JT. An intensive telehealth assessment and treatment model for an adult with developmental disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 111:103876. [PMID: 33524736 DOI: 10.1016/j.ridd.2021.103876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Over the last decade, the provision of applied behavior analysis (ABA) services within a telehealth delivery format has had a flourishing literature base. Research has demonstrated that caregivers can successfully conduct functional analyses and functional communication training to treat challenging behavior with coaching from practitioners via telehealth. Previous limitations include research that has only been conducted with children, typically in 1hr, weekly meetings, so the utility of providing ABA therapy via telehealth across the lifespan is unknown. Additionally, the effects of a more intensive treatment format delivered via telehealth has not been evaluated. The purpose of the current study was to coach caregivers to conduct the assessment and treatment process for a young man with developmental disabilities using an intensive-outpatient model in a telehealth format. Functional analysis procedures led to the development of a function-based treatment to reduce challenging behavior and increase functional communication. Caregivers demonstrated high procedural integrity across all phases of the study and found the intervention highly acceptable and effective. Areas for future research and directions are discussed.
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Affiliation(s)
- Lesley A Shawler
- Department of Behavioral Psychology, Kennedy Krieger Institute, United States; Johns Hopkins University School of Medicine, United States.
| | - Joy C Clayborne
- Department of Behavioral Psychology, Kennedy Krieger Institute, United States
| | - Brian Nasca
- Department of Behavioral Psychology, Kennedy Krieger Institute, United States; Johns Hopkins University School of Medicine, United States
| | - Julia T O'Connor
- Department of Behavioral Psychology, Kennedy Krieger Institute, United States; Johns Hopkins University School of Medicine, United States
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Pierson LM, Thompson JL, Ganz JB, Wattanawongwan S, Haas AN, Yllades V. Coaching Parents of Children With Developmental Disabilities to Implement a Modified Dialogic Reading Intervention Using Low Technology via Telepractice. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:119-136. [PMID: 33352059 DOI: 10.1044/2020_ajslp-20-00037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Purpose Storybook reading provides a naturalistic context to promote bonding and increase oral communication between the reader and child. This study investigated the impact of modified dialogic reading procedures, which included a prompting component on the language skills of children with autism spectrum disorder and Down syndrome in the children's homes. Method A multiple-probe-across-participants design was used to investigate the efficacy of the intervention for this population. Parent training and coaching were provided via telepractice. Maintenance and generalization sessions were also conducted. Results A functional relation was observed between parent implementation and telepractice coaching. Conclusion While the child responses to comprehension questions did not change, changes in the parent implementation of modified dialogic reading procedures in response to coaching via telepractice were noted in this study. Supplemental Material https://doi.org/10.23641/asha.13382831.
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Affiliation(s)
- Lauren M Pierson
- Department of Educational Psychology, Texas A&M University, College Station
| | - Julie L Thompson
- Department of Educational Psychology, Texas A&M University, College Station
| | - J B Ganz
- Department of Educational Psychology, Texas A&M University, College Station
| | | | - April N Haas
- Department of Educational Psychology, Texas A&M University, College Station
| | - Valeria Yllades
- Department of Educational Psychology, Texas A&M University, College Station
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Pollard JS, LeBlanc LA, Griffin CA, Baker JM. The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. J Appl Behav Anal 2021; 54:87-102. [PMID: 33369729 PMCID: PMC7898711 DOI: 10.1002/jaba.803] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/16/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023]
Abstract
Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID-19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from in-person to telehealth delivery of treatment when shelter-in-place orders were issued. Of these cases, 76% of participants transitioned to technician-delivered telehealth services whereas the rest transitioned to a caregiver-implemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (in-person M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from in-person treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from technician-delivered telehealth services.
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Affiliation(s)
- Joy S. Pollard
- Behavior Change Institute
- Stanford University School of Medicine
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Baumes A, Čolić M, Araiba S. Comparison of Telehealth-Related Ethics and Guidelines and a Checklist for Ethical Decision Making in the Midst of the COVID-19 Pandemic. Behav Anal Pract 2020; 13:736-747. [PMID: 32837709 PMCID: PMC7430127 DOI: 10.1007/s40617-020-00475-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Applied behavior analysis (ABA) services have been provided primarily in the fields of health care and education across various settings using an in-person service delivery model. Due to the COVID-19 pandemic, the necessity of and demand for ABA services using telehealth have increased. The purpose of the present article was to cross-examine the ethical codes and guidelines of different, but related fields of practice and to discuss potential implications for telehealth-based ABA service delivery. We reviewed the telehealth-specific ethical codes and guidelines of the American Psychological Association, the American Academy of Pediatrics, and the National Association of Social Workers, along with the related ABA literature. These organizations addressed several useful and unique ethical concerns that have not been addressed in ABA literature. We also developed a brief checklist for ABA practitioners to evaluate their telehealth readiness by meeting the legal, professional, and ethical requirements of ABA services.
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Affiliation(s)
- Andrea Baumes
- Positive Behavior Support Corporation, Honolulu, HI USA
| | - Marija Čolić
- Special Education Department, University of Hawaii at Manoa, Honolulu, HI USA
| | - Sho Araiba
- Positive Behavior Support Corporation, Honolulu, HI USA
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Watson SL, Stine F, Tumin D, Stiles KM. Employment and well-being among caregivers of children with autism spectrum disorder. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1810576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sarah L. Watson
- Department of Sociology, East Carolina University, Greenville, NC, USA
| | - Fritz Stine
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Karen M. Stiles
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, NC, USA
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Schieltz KM, Wacker DP. Functional assessment and function-based treatment delivered via telehealth: A brief summary. J Appl Behav Anal 2020; 53:1242-1258. [PMID: 32643811 PMCID: PMC7361834 DOI: 10.1002/jaba.742] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 11/10/2022]
Abstract
As the world navigates the COVID-19 health crisis, behavior analysts are considering how best to support families while maintaining services and ensuring the health and safety of everyone involved. Telehealth is one service delivery option that provides families with access to care in their own communities and homes. In this article, we provide a brief summary of the telehealth literature in applied behavior analysis that provided coaching and training to families for individuals who displayed challenging behavior. These studies targeted functional assessment and function-based treatment for challenging behavior. We briefly summarize what is known relative to the assessment and treatment of challenging behavior via telehealth, place these results within a descriptive context of the decisions made by the research team at the University of Iowa, and discuss what we, as behavior analysts, should consider next to advance our understanding and practice of telehealth.
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Fronapfel BH, Demchak M. School's Out for COVID-19: 50 Ways BCBA Trainees in Special Education Settings Can Accrue Independent Fieldwork Experience Hours During the Pandemic. Behav Anal Pract 2020; 13:312-320. [PMID: 32637294 PMCID: PMC7250264 DOI: 10.1007/s40617-020-00434-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Due to the COVID-19 pandemic and nationwide executive orders closing schools, many trainees completing their supervised independent fieldwork in educational settings lost the ability to accrue hours linked to restricted activities of a therapeutic and instructional nature with students (i.e., clients). Given the impact on trainees of the pandemic restrictions, we present 50 suggestions for trainees in school settings to continue to accrue hours for both restricted and unrestricted activities throughout the course of the COVID-19 pandemic.
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Affiliation(s)
- Brighid H. Fronapfel
- Center for Excellence in Disabilities, University of Nevada, Reno, Mailstop 0285, 1664 N. Virginia Street, Reno, NV 89557 USA
| | - MaryAnn Demchak
- Special Education Program, University of Nevada, Reno, Mailstop 0299, 1664 N. Virginia Street, Reno, NV 89557 USA
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