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Inoue M, Yamaguchi H, Nakatani K, Nishimoto A, Namiki K, Kuroda S, Tran TVH, Dinh NTT. Effectiveness of Online Parent Training for Vietnamese Parents of Children with Autism Spectrum Disorders. Yonago Acta Med 2024; 67:213-224. [PMID: 39176193 PMCID: PMC11335923 DOI: 10.33160/yam.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/17/2024] [Indexed: 08/24/2024]
Abstract
Background Parent training (PT) programs have been implemented for neurodevelopmental disorders such as autism spectrum disorder (ASD) in recent years. However, in Southeast Asia, the diffusion of rehabilitation programs for children with ASD and that of PT as a parental support measure has been slow. Methods This study assessed the effectiveness of an online PT program that was developed in Japan and remotely delivered to Vietnamese parents of children with ASD residing in Vietnam. Sixteen parents of Vietnamese children with ASD participated in seven online Tottori University-style PT sessions. The online PT was conducted in real-time from Japan, considering the two-hour time difference between countries. Lectures and exercises were presented in Vietnamese with PowerPoint materials. Japanese staff provided explanations in Japanese, which were then simultaneously translated by a Vietnamese interpreter. Attendance, completion of homework assignments, and the number of statements on Zoom and social media were tallied. A pre-post-test design was employed to measure changes in parents' mental health factors and children's behavior. A post-intervention questionnaire was administered to assess participant's acceptance of PT. Results The findings showed that attendance and task completion rates were considerably high. The study found that the mental health scores of parents significantly improved after participating in online parenting training compared to before. However, there were no statistically significant improvements found in children's behavior. The study also confirmed high satisfaction with the cross-country online parenting training. Conclusion This study confirmed that TUPT, developed in Japan and implemented as an online PT for parents of children with ASD living in Vietnam, was effective in improving parental mental health. The program acceptability questionnaire also showed positive results. This study is the first step in the evaluation and dissemination of Internet-based, cross-country parent training for parental support in Asia.
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Affiliation(s)
- Masahiko Inoue
- Graduate School of Medical Sciences, Tottori University, Yonago 683-8503, Japan
| | - Honami Yamaguchi
- Office for Promotion of Base Hospitals for Children's Psychological Treatment, Tottori University, Yonago 683-8503, Japan
| | - Keita Nakatani
- Office for Promotion of Base Hospitals for Children's Psychological Treatment, Tottori University, Yonago 683-8503, Japan
| | - Ayano Nishimoto
- Graduate School of Medical Sciences, Tottori University, Yonago 683-8503, Japan
| | - Kei Namiki
- Graduate School of Medical Sciences, Tottori University, Yonago 683-8503, Japan
| | | | | | - Nguyen Trang Thu Dinh
- Department of Special Education, Hanoi National University of Education, Hanoi 11350, Vietnam
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Devagiri B, Ariyasena ADK, Siriwardhana DD, Sumanasena S. Telehealth services for children with neuro-developmental disabilities in the Asia-Pacific region: A systematic review. Child Care Health Dev 2024; 50:e13192. [PMID: 38049949 DOI: 10.1111/cch.13192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/14/2023] [Accepted: 10/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND In recent years telehealth became a popular and a rational health service delivery approach, especially amidst multiple challenges posed while providing health care interventions during the COVID-19 pandemic. AIM We synthesized available evidence on telehealth for managing children with NDDs in the Asia-Pacific region with the aim of identifying successful methods. METHODOLOGY We systematically reviewed six electronic databases: MEDLINE, AMED, EMBASE, PsychInfo, Web of Science, and (CINAHL plus) using the keywords and database-specific subject headings from their inception to 25th August 2021. Review findings were synthesized narratively, and harvest plots were used to demonstrate the effect of interventions. The protocol and reporting the findings of this review adhered to PRISMA 2020 guidelines. PROSPERO registration: CRD 340690. RESULTS We harvested 30,823 records; 17,563 duplicates were removed, and 196 full-text articles were assessed for eligibility. 16 studies with multiple research designs were included in the review. Eight were from the Pacific region and eight represented Asia. The interventions targeted families and children with a variety of NDDs (autism spectrum disorder, Down syndrome, cleft lip and palate, hearing impairment, cerebral palsy etc.) via telehealth. Telehealth packages consisted of direct and indirect methods of synchronous, asynchronous, and hybrid approaches. All studies used parent-led intervention strategies. Telehealth reported a positive effect in 7/16 studies while five showed a neutral effect. CONCLUSIONS According to published evidence telehealth for children with NDDs is an evolving, evidence-based service facilitation modality in the Asia-Pacific region, with only a few published randomized controlled trials. The systematic review shows promising telehealth practices emerging across the region despite the diversity in NDDs studied.
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Affiliation(s)
- Bhagya Devagiri
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Ayati, National Centre for Children with Disabilities, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | | | - Dhammika Deepani Siriwardhana
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Samanmali Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
- Ayati, National Centre for Children with Disabilities, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
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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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Kalb LG, Kramer JM, Goode TD, Black SJ, Klick S, Caoili A, Klipsch S, Klein A, Urquilla MP, Beasley JB. Evaluation of telemental health services for people with intellectual and developmental disabilities: protocol for a randomized non-inferiority trial. BMC Health Serv Res 2023; 23:795. [PMID: 37491216 PMCID: PMC10369796 DOI: 10.1186/s12913-023-09663-6] [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] [Received: 05/09/2023] [Accepted: 06/07/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Roughly 40% of those with intellectual/developmental disabilities (IDD) have mental health needs, twice the national average. Unfortunately, outpatient mental health services are often inaccessible, increasing reliance on hospital-based services. While telemental health services hold potential to address this gap, little is known about the effectiveness of telemental health for the diversity of persons with IDD, especially as it relates to crisis prevention and intervention services. Accordingly, the aims of this study are to: (1) compare telemental health versus in-person crisis prevention and intervention services among people with IDD; and (2) understand if outcomes vary across subpopulations, in order to identify potential disparities. METHODS This study will take place within START (Systemic, Therapeutic, Assessment, Resources, and Treatment), a national evidence-based model of mental health crisis prevention and intervention for people with IDD. A total of 500 youth and adults, located across nine states, will be randomized 1:1 to telemental health vs. in-person. Participant inclusion criteria are ages 12-45 years, living in a family setting, and newly enrolled (within 90 days) to START. Outcomes will be assessed, using a non-inferiority design, for up to 1 year or until discharge. The intervention is comprised of four components: (1) outreach; (2) consultation/coping skills; (3) intake/assessment; and, (4) 24-hour crisis response. The in-person condition will deliver all components in-person. The telemental health condition will deliver components 1 & 2, via telephonic or other communication technology, and components 3 & 4 in-person. Outcomes include mental health crisis contacts, mental health symptoms, emergency psychiatric service use, perceived quality of mental healthcare, and time to discharge. DISCUSSION To our knowledge, this will be the first trial of a telemental health crisis program for the IDD population. The study will be executed by an interdisciplinary team of experts that includes persons with lived experience of disability. Understanding the benefits of specific telemental health methods has important implications to the design of interventions. This telemental health study offers promise to address disparities in access to mental health care for people with IDD across diverse racial, ethnic, linguistic, and cultural groups. TRIAL REGISTRATION Clinicaltrials.gov ( #NCT05336955 ; Registration Date: 4/20/2022).
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Affiliation(s)
- Luther G Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 N. Broadway, 8th Floor, Baltimore, MD, 21205, USA.
| | | | - Tawara D Goode
- Georgetown National Center for Cultural Competence, Washington, USA
- Department of Pediatrics, Georgetown University Medical Center, Washington, USA
| | - Sandra J Black
- Department of Social Work, University of New Hampshire, Durham, USA
| | - Susan Klick
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
| | - Andrea Caoili
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
| | - Samantha Klipsch
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
| | - Ann Klein
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
| | - Micah P Urquilla
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
| | - Joan B Beasley
- Institute on Disability/UCEDD, University of New Hampshire, Durham, USA
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Telehealth information and communication technology access for family caregivers of people with intellectual and developmental disabilities and mental health needs. Disabil Health J 2023:101463. [PMID: 37024396 DOI: 10.1016/j.dhjo.2023.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/02/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Telehealth is increasingly used to deliver mental health services. However, the potential benefits of telehealth for people with intellectual and developmental disabilities and mental health needs (IDD-MH) may not be fully realized. This study addresses gaps in knowledge about access to information and communication technologies (ICTs) for individuals with IDD-MH from the perspective of their family caregivers. OBJECTIVE What factors are associated with access to ICTs among family caregivers of people with IDD-MH who use START services? METHODS Retrospective analysis of cross-sectional interview data gathered for START use at the onset of COVID-19. START is a crisis prevention and intervention evidence-based model for people with IDD-MH implemented across the USA. To assess needs during COVID-19, START coordinators conducted interviews with 1455 family caregivers between March and July 2020. A multinomial regression model examined correlates of ICT access, as indicated by an index (poor, limited, and optimal access). Correlates included the level of IDD, age, gender, race, ethnicity, rural setting of the person with IDD-MH, and caregiver status. RESULTS Age (ages 23-30 years) and sole caregiver status were significantly associated with limited access (both p ≤ .001). Age (ages 23-30 years and ≥31 years, p < .001), race (Black or African American, p = .001), ethnicity (Hispanic, p = .004), and sole caregiver status (p < .001) were significantly associated with poor access. CONCLUSIONS Disparities existed in ICT access for adults, specific racial/ethnic groups, and sole caregiver households. Healthcare policy related to telehealth must consider how ICT access can be equitable for all users with IDD-MH.
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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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Shawler LA, Senn LP, Snyder K, Strohmeier C. Using Telehealth to Program Generalization of Caregiver Behavior. Behav Anal Pract 2022; 16:1-12. [PMID: 36568322 PMCID: PMC9765369 DOI: 10.1007/s40617-022-00766-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Stokes and Baer, Journal of Applied Behavior Analysis, 10(2), 349-367 (1977) provided guidelines to assist practitioners with programming for the generalization of behavior change. Despite the suggestions provided in their seminal paper, generalization remains an often overlooked area within behavior analytic research and practice. In addition, few studies have described explicit strategies to program for the generalization of caregiver behaviors that are consistent with interventions to reduce child challenging behavior. In the current discussion, we describe how telehealth provides a potential avenue for practitioners to focus on generalization. Telehealth helps practitioners access behavior-change agents, materials, and contexts that they may not directly contact in educational and clinical environments. Using telehealth to target these areas early on, and throughout treatment for child challenging behavior, may facilitate more rapid treatment success and maintenance. We provide a case example to demonstrate the use of telehealth to program the generalization of a mother's treatment plan implementation to reduce the severe challenging behavior of an adolescent. We report clinically and socially significant outcomes related to caregiver fidelity and challenging behavior reduction.
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Affiliation(s)
- Lesley A. Shawler
- Kennedy Krieger Institute, Baltimore, MA USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Laura Perry Senn
- Kennedy Krieger Institute, Baltimore, MA USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | - Craig Strohmeier
- Kennedy Krieger Institute, Baltimore, MA USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
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