ABA is Brought to You By…Telehealth!
By: Robert O’Hare, MS, BCBA, LBA (NY), LABA (MA)
Services based on the science of Applied Behavior Analysis (ABA) are traditionally delivered in a face-to-face format, whereby a Board Certified Behavior Analyst (BCBA) and behavior technician work directly with an individual in the client’s home, school, or clinic-based setting. Telehealth, or medical services that are delivered through a technological medium (i.e., videoconferencing, email, webinars, etc.), historically have been considered an alternative for individuals whose accessibility to services in “brick and mortar” settings was impractical or impossible (Tomlinson, Gore, and McGill, 2018) or for when “wait times for outpatient behavioral clinics are often 6 months or longer” (Wacker et al., 2013), thereby necessitating methods such as Telehealth.
The COVID-19 pandemic required many families and organizations to transition ABA services to a remote, telehealth-based model. Researchers Pollard, LeBlanc, Griffin, and Baker (2020) conducted a review of archived data of individuals who had received 1:1, direct, home-based ABA services prior to the onset of the pandemic but switched to a telehealth model when COVID-19 appeared. Results from this review indicated that the transition to telehealth for these individuals with Autism Spectrum Disorder (ASD) succeeded, with minimal interruption in services (Pollard et al., 2020). The results of this study also provide preliminary evidence regarding the importance of foundational skills necessary to make the switch to telehealth successful, which included:
Joint Attention- The shared focus on an item such as a tablet. Ideally for 8-10 minutes when it comes to sitting with the computer or tablet.
Basic Discrimination Skills- Making an appropriate choice when presented with a variety of different options, such as making requests with picture cards and icons (e.g., PECs).
Basic Echoic Skills- Repeating exactly what another person said, such as Person A saying “Hello!” and Person B saying “Hello!” in response.
Basic Motor Imitation Skills- Copying another person’s physical movements,
Following Simple One-Step Directions- The instructor says “raise hand” and a student performs the action when they are directed over a computer screen.
Some Independence from Caregiver- Ability to participate in session with limited hands-on assistance from the caregiver.
Absence of Severe Challenging Behaviors- Safety concerns and challenging behavior are low and/or caregivers are safely and effectively able to manage any challenging behavior that is present.
Provided below are more studies that describe how ABA has been delivered effectively via telehealth to train staff and provide services directly to individuals:
Wacker et al (2013a) looked at whether training parents over telehealth would be a feasible and effective way to implement Functional Analyses (FAs) with individuals with Autism Spectrum Disorder (ASD). FAs are used by behavior analysts to determine the purpose(s) of problem behaviors, such as physical aggression toward people, self-harm (e.g., head-hitting), and destroying property. Using this telehealth model, parents with no prior ABA experience were successfully able to implement these FA procedures.
In a follow-up to the previous study on FAs, Wacker et al. (2013b) investigated the impact of training parents with no prior training of ABA procedures to implement Functional Communication Training (FCT) via telehealth. FCT involves teaching individuals more acceptable ways of communicating their needs as a replacement for problem behaviors, such as a learner saying “cookie” instead of hitting someone who then gives them a cookie! The training method employed by Wacker et al. (2013b) resulted in a 68.7% reduction in problem behavior for each child in the study, but the majority showed over a 90% decrease. The comparison of cost for each therapist for 192 total visits was $11,500 via telehealth, $55,872 for in-person visits. Also, therapists would have needed to drive over 1,100 hours for in-person therapy.
Pellegrino and Reed (2020) studied the effectiveness of using telehealth-based instruction to teach independent living skills in adults with Intellectual and Developmental Disability (IDD). Two adults diagnosed with IDD participated in this study. The skills that were targeted for acquisition involved making a quesadilla, filling out a ledger, and folding origami. Video conferencing was supplemented with written instructions suited for each participants’ reading level.
Sump et al (2018) compared the effectiveness of training eight undergraduate students via in-person and telehealth modalities. Four skills were evaluated: “instructional context, antecedent instructional control strategies, multiple stimulus without replacement preference assessment (DeLeon & Iwata, 1996), and consequences for accurate and inaccurate student responses…”(p. 468). Telehealth and in-person training were equally effective in training the target skills to these students.
The above studies provide a snapshot of how the field of Behavior Analysis has incorporated telehealth into ABA service delivery to individuals with ASD, Intellectual and Developmental Disabilities, and for the purposes of training staff and parents. With research such as the studies cited above establishing its efficacy, telehealth has provided our field with an effective option for those who would otherwise be without services during the COVID-19 pandemic.
Sources:
DeLeon, I. G., & Iwata, B. A. (1996). Evaluation of a multiple-stimulus presentation format for assessing reinforcer preferences. Journal of Applied Behavior Analysis, 29, 519-533. https://doi.org/10.1901/jaba.1996.29-519
Pellegrino, A. J. & DiGennaro Reed, F. D. (2020). Using telehealth to teach valued skills to adults with intellectual and developmental disabilities. Journal of Applied Behavior Analysis, 53, 1276-1289. https://doi.org/10.1002/jaba.734
Pollard, J. S., LeBlanc, L. A., Griffin, C. A., & Baker, J. M. (2020). The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. Journal of Applied Behavior Analysis, 54, 87-102. https://doi.org/10.1002/jaba.803
Sump, L. A., Richman, D. M., Schaefer, A. M., Grubb L. M., & Brewer, A. T. (2018). Telehealth and in-person training outcomes for novice discrete trial training therapists. Journal of Applied Behavior Analysis, 51(3), 466-481. https://doi: 10.1002/jaba.461
Tomlinson, S. R. L., Gore, N. & McGill, P. Training individuals to implement applied behavior analytic procedures via telehealth: A systematic review of the literature. Journal of Behavioral Education, 27, 172–222. https://doi.org/10.1007/s10864-018-9292-0
Wacker, D. P., Lee, J. F., Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., Pelzel, K. E., & Waldron, D. B. (2013). Conducting functional analyses of problem behavior via telehealth. Journal of Applied Behavior Analysis, 46(1), 31–46. https://doi.org/10.1002/jaba.29
Wacker, D. P., Lee, J. F., Padilla Dalmau, Y. C., Kopelman, T. G., Lindgren, S. D., Kuhle, J., Pelzel, K. E., Dyson, S., Schieltz, K .M., & Waldron, D. B. (2013). Conducting functional communication training via telehealth to reduce the problem behavior of young children with Autism. Journal of Developmental and Physical Disabilities, 25(1), 35-48. https://doi: 10.1007/s10882-012-9314-0
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