Telehealth and Autism: Treating Challenging Behavior at Lower Cost

Abstract

OBJECTIVE: To determine whether challenging behavior in young children with autism and other developmental disabilities can be treated successfully at lower cost by using telehealth to train parents to implement applied behavior analysis (ABA). METHODS:We compared data on the outcomes and costs for implementing evidence-based ABA procedures to reduce problem behavior by using 3 service delivery models: in-home therapy, clinic-based telehealth, and home-based telehealth. Participants were 107 young children diagnosed with autism or other neurodevelopmental disorders, and data analysis focused on the 94 children who completed treatment. RESULTS:All 3 service delivery models demonstrated successful reduction of problem behavior by training parents to conduct functional analysis and functional communication training. The mean percentage reduction in problem behavior was >90% in all 3 groups after treatment, and treatment acceptability based on parent ratings was high for all groups. Total costs for implementing treatment were lowest for home telehealth, but both telehealth models were significantly less costly than in-home therapy.CONCLUSIONS: This research demonstrated that parents can use ABA procedures to successfully treat behavior problems associated with autism spectrum disorders regardless of whether treatment is directed by behavior consultants in person or via remote video coaching. Because ABA telehealth can achieve similar outcomes at lower cost compared with in-home therapy, geographic barriers to providing access to ABA for treating problem behavior can be minimized. These findings support the potential for using telehealth to provide researchbased behavioral treatment to any family that has access to the Internet.

Training Individuals to Implement Applied Behavior Analytic Procedures via Telehealth: A Systematic Review of the Literature

“…Across these 20 articles, 113 agents were trained in behavioral techniques via telehealth by at least 27 trainers (it was not possible to determine the number of trainers for three articles: Alnemary et al 2015;Lindgren et al 2016;Wainer and Ingersoll 2015), and 104 children received support from someone who had been trained via telehealth. In some cases, additional individuals were also trained including four trainees as part of a wait list control group (Fisher et al 2014), and 53 individuals who were trained via in-person methods as a comparison group (Hay-Hansson and Eldevik 2013; Lindgren et al 2016). Table 2 provides an overview of each included study.…”

“…Studies were conducted by research teams primarily located in the USA, with one study conducted by a research team in Norway. Where information was reported on the distance over which telehealth support was provided, distances varied from a different room in the same building (Higgins et al 2017;Machalicek et al 2009b), a different location under 100 miles away (Barretto et al 2006;Gibson et al 2010;Lindgren et al 2016;Machalicek et al, 2009a;Machalicek et al 2016;Neely et al 2016), between 100 and 200 miles away (Barretto et al 2006;Lindgren et al 2016;, or over 200 miles away (Knowles et al 2017;Lindgren et al 2016;Wacker et al 2013a, b). In three cases, training was provided for trainees in a different country located 300 (Wainer and Ingersoll 2015), 5863 (Barkaia et al 2017), and8333 (Alnemary et al 2015) miles away from the trainer.…”

“…Other researchers cited knowledge gaps relating to effectiveness, efficiency or agent fidelity when training is conducted via telehealth Suess et al 2014). Finally, some researchers highlighted the need to compare delivery formats (Lindgren et al 2016) 1 3 J Behav Educ (2018) 27:172-222 or evaluate the use of particular training techniques and behavioral procedures (Higgins et al 2017;Neely et al 2016;Wainer and Ingersoll 2015), while others cited methodological considerations relating to telehealth research including the use of a randomly controlled or multiple baseline design (Fisher et al 2014;Higgins et al 2017), the incorporation of telehealth into existing support models , or the use of specific technology and software Machalicek et al 2009b). …”

“…For example, in six articles (Higgins et al 2017;Machalicek et al 2009aMachalicek et al , b, 2010Machalicek et al , 2016Neely et al 2016), it was explicitly stated that trainers were Board Certified Behavior Analysts. Trainers were often Doctoral or Master's students Higgins et al 2017;Knowles et al 2017;Lindgren et al 2016;Machalicek et al, 2009aMachalicek et al, , b, 2010Suess et al 2014Wacker et al 2013a, b) and trainees had varying levels of experience using behavioral approaches, ranging from one ) to 20 years' experience of implementing behavioral techniques (Wacker et al 2013a). …”

Reducing Cost Through Standardization

“…The treatment outcomes did not vary, but total facility, provider, and family costs were reduced by a minimum of 49 % per treatment period. Another opportunity to reduce costs is the use of checklists and decision support to limit the utilization of unnecessary laboratory testing [32]. Algaze and others demonstrated marked reduction in a number of basic laboratory tests by using these methods in a cardiac intensive care unit that resulted in actual yearly cost savings of $717,538 without negative impact on clinical outcomes or mortality rate or length of stay [33].…”