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Telehealth Evolution: Continuing ABA-Based Therapy During the COVID-19 Crisis

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Telehealth Evolution: Continuing ABA-Based Therapy During the COVID-19 Crisis

April 16, 2020 | Edwin Tsai, MS, BCBA

Continuity of care for your child with autism or other developmental disability is essential to the success of your child’s ABA-based behavioral therapy program, and maintaining a regular therapy schedule is critical. But as we all deal with the COVID-19 public health crisis and strive to maintain physical and social distancing, continuing your child’s program can present a challenge because you may not feel comfortable allowing your child’s clinical team members into your home right now. This is understandable. Thankfully, using a telehealth-based approach may be the answer.

If your child has been receiving in-home behavioral therapy services, you may have heard of telehealth as a way for your child to receive their behavioral therapy. But you may have questions about this approach, and you may be wondering about how it’s different from traditional ABA-based therapy. The simple answer is . . . it’s not much different.

Traditional ABA-Based Therapy

With traditional ABA-based behavioral therapy, a Behavior Interventionist (BI) works 1:1 with your child in your home. The BI implements an established treatment plan, which may involve teaching your child important adaptive skills, communication skills, self-care skills and social skills.

The treatment plan is customized specifically for your child by a Board-Certified Behavior Analyst (BCBA), and your BCBA works closely with the BI and oversees all aspects of treatment. Sometimes the BI visits your home alone, and sometimes the BI visits with the BCBA who is supervising your child’s case. When the BI and BCBA visit your child together, the visit is called a supervisory visit.

Using Telehealth for Supervisory Visits

When using telehealth for a supervisory visit, your BI still visits your home and conducts your child’s session face-to-face. But instead of coming in person, the BCBA participates by providing direction from a distant site – video conferencing or teleconferencing into the session using a computer or other mobile device. This approach increases access to the BCBA, maintains treatment goals and outcomes, maintains coordination of care, and expands your child’s access to services during this challenging time.

The approach allows for a greater degree of physical and social distancing for you and your family because fewer people need to come into your home to provide services for your child. This alleviates the pressures of having too many people coming into your home, and having fewer people in the home makes many parents feel more comfortable continuing important ABA-based treatment for their child.

Using Telehealth for Direct Care

Conducting supervisory visits via telehealth can go a long way to help you maintain physical and social distancing in your home. But the BI still needs to come in to conduct sessions. For some families, continuing in-home direct services may still create discomfort. If this is the case for you and your family, receiving direct services through telehealth may be an option for you.

With this approach, the BI conducts sessions from a distant site – video conferencing in to your and your child’s computer, tablet or phone. The BCBA can also join sessions, as needed, to complete supervisory visits and ensure your child’s program is on track. With this approach, your child’s care can continue without anyone coming into your home.

Considerations Before Starting Direct Care Via Telehealth

Telehealth services are not appropriate for every child or every household. There are several considerations that need to be addressed before determining if telehealth-based services are right for you.

  1. A risk and safety assessment must be completed to identify any safety concerns that might arise during sessions. This includes determining if your child exhibits self-injurious behavior, may run away from the area where the sessions will be conducted, is inclined to throw objects or destroy property, or other similar concerns. If your child is likely to exhibit unsafe behaviors during sessions, direct telehealth-based therapy might not be the best fit. But telehealth-based parent training might be appropriate to help you better manage these behaviors.
  2. A skill assessment is necessary to determine if your child can effectively participate in direct telehealth-based sessions. The ability to attend to a tablet or computer screen, listen to and follow basic instructions (come here, look at me, sit down, etc.), respond and redirect attention to the screen if their name is called, and work on a task for more than 5 minutes are some of the skills needed for successful participation in telehealth sessions.
  3. Determining if your child’s treatment goals are appropriate for a telehealth-based approach. Goals that work well with telehealth include communication skills and social play. Other goals, such as self-care, are not as appropriate or effective via telehealth.
  4. Identifying a quiet area in your home where telehealth sessions can be conducted without any distractions. Having a designated area available is essential.
  5. Ensuring your child has a smartphone, tablet or computer that can run a teleconferencing application – like ZOOM® – without slowing down, along with an internet connection that provides little to no lag in audio and video. Access to appropriate equipment is essential.
  6. Confirming that you will be available at all times when sessions are in progress – in case there is a need to redirect the child.

How Does a Telehealth-Based Direct Care Visit Work?

Once all the considerations above have been addressed and an appropriate authorization for services is received, sessions can begin. Some elements of  telehealth-based sessions will be the same as would occur during in-person sessions, and some elements will be different.
The structure of a typical telehealth session is as follows:

  1. The BI contacts the family at the scheduled session time to discuss how the session will be carried out, present the lesson plan for the day, relate other details about the session, and address any questions family members may have. The BI will also ensure your child is in a quiet area and ready to participate in the session.
  2. The session is initiated by the BI using a videoconferencing application such as ZOOM®.
  3. The BI conducts the session much the same as they would if they were actually in your home.
    • First, the BI explains to your child what’s going to happen during the session – the same way they would in a home-based session.
    • Then, the BI kicks things off with an interactive activity that the child will enjoy. This activity might be a computer-based game of Uno or Tic-Tack-Toe. Starting with a fun activity is the same structure you’d see in a home-based session.
    • Next, the BI will move into the specific program for the day, engaging the child in a lesson that is customized to your child and his or her treatment goals. The BI continually monitors your child to ensure he or she is sustaining attention to the task. Again, this is the same structure you’d see in a home-based session. The only difference is that the BI and your child complete the lesson “virtually” rather than face-to-face.
    • After a few activities are completed, your child has an opportunity to take a break, get up, walk around, get a snack, etc. – just as they would in an in-home session. After the break, the session resumes.
  4. During the session, you or another caregiver is present to help with any physical support that is needed. This can include redirecting your child back to the screen or bringing your child back to the work place if they leave the area. You or another caregiver also helps if your child is having issues with using the computer or tablet.
  5. When the session is over, the BI speaks with you or another caregiver about the progress during session. Again, this is similar to what happens in an in-home session. After this debrief, the BI signs off.

Final Thoughts

California Psychcare has experience providing telehealth-based behavioral therapy – and the protocols, procedures and technology that are proven effective and that maintain confidentiality and privacy are in place. Our clinicians are trained and ready to deliver these services to your child immediately. We are ready, willing and able to transition current clients to a telehealth-based approach, if it is appropriate. We are also accepting new telehealth referrals from all insurance companies, health plans and regional centers.

If you think ABA-based behavioral therapy via telehealth may be beneficial as an approach to continue treatment for your child during these uncertain times, we invite you to call our TELEHEALTH HOTLINE at 818.474.1514.

About the Author

For more than 10 years, Edwin has been working with the developmentally disabled in Riverside, Los Angeles and San Diego. He has extensive experience working side-by-side with child and adult services agencies, and in the court system. He has a Master of Science in Applied Behavior Analysis (ABA) and has provided ABA-based therapy to children with autism, as well as providing staff and parent trainings on ABA concepts and principles.

Edwin is a true leader, with a true passion for helping families in need. He appreciates his teammates who really care about what they do, and who care deeply for the families they serve. Edwin’s dedication to his teammates and his clients is inspiring.

In his personal time Edwin plays guitar and fire dances, which helps him unwind and expand himself creatively so he can use that energy in his work.

Edwin Tsai
Edwin Tsai, MS, BCBA

Director of Clinical Services
California Psychcare

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