While telehealth has been utilized to deliver Applied Behavior Analysis (ABA) services for over 15 years (Barretto et al., 2006; Ferguson et al., 2019), the global coronavirus pandemic precipitated a seismic shift in service delivery toward this modality. In April 2020, the Council of Autism Service Providers (CASP) pioneered the first industry practice parameters for telehealth implementation of ABA services. CASP is an association of provider organizations serving individuals with autism spectrum disorders (ASD) and is focused on defining industry standards and outcomes in the delivery of evidence-based ABA practices.

Existing research literature at the time supported the use of telehealth to deliver certain ABA services; however, it was limited in scope and breadth. An abundance of subsequent studies have further bolstered the knowledge-base on a variety of clinical applications in ABA that can be supported via telehealth  (Feguson, Craig & Dounavi, 2019). These include caregiver training and 1:1 or group therapy models, targeting adaptive skill acquisition and reduction of challenging behaviors. 

As a result of the widespread application and continued evidence supporting telehealth in delivering ABA care, healthcare funders have been called upon to continue authorizing its use past the pandemic, and consumers have additional choices regarding their treatment. With the evolution of telehealth in ABA, CASP updated its practice parameters  in December 2021 to include important learnings from the past two years. In this updated guide, CASP identifies five key benefits of telehealth-delivered ABA and defines three different ways telehealth can be delivered effectively. 

Benefits of Telehealth

1) Improves access to care
There is a shortage of ABA practitioners nationwide, so families often face a lack of providers in their communities and/or long waitlist times that can last upwards of  2 years before connecting with a provider who can help. This means missing out on interventions aimed at improving quality of life,  often during critical windows in one’s developmental trajectory. In certain cases, telehealth may offer 1) an effective alternative to in-person care or 2) an interim solution to those who ultimately desire in-person care, but find themselves on long waiting lists before they will be able to access it.

‍2) Reduces provider burnout
Telehealth eliminates “windshield time,” traveling to and from appointments for in-person care settings.  The field of ABA service delivery experiences a high degree of provider turnover, particularly at the Registered Behavior Technician (RBT) level. As such, reducing burnout is critical to meeting the needs of consumers of ABA services.

3) Improves coordination among providers
Telehealth allows access to a wider pool of clinicians with specialties that match an individual’s unique needs than would otherwise be available to them in person. It also allows for easier coordination among multidisciplinary treatment teams by eliminating travel to meetings and allowing members to participate from various locations. 

4) Promotes continuity of care
Service interruptions due to inclement weather and sickness or quarantine/isolation of family members during the pandemic can be reduced or avoided with telehealth-implemented ABA care. 

5) Reduces cost and improves efficiency
Telehealth helps to save organizations and families money by eliminating travel costs to attend appointments. It can also assist meet family’s scheduling needs and reduce the need for working caregivers to take leave from work to participate in care. 

Telehealth Service Delivery Models

1) In-person Direct Services with Telehealth Clinical Direction: This model offers a hybrid telehealth approach in which direct care is provided in-person by behavior technician(s), and the behavior analyst provides remote clinical supervision. 

2) Telehealth Direct Services: In this model, direct 1:1 or group care is provided via telehealth in real-time using video conferencing.

3) Caregiver-Mediated Services: In this model, parents/caregivers receive training and feedback from the behavior analyst on treatment plan protocols via real-time via video conferencing. This can be combined with “offline” methods of communication, such as store-and-forward video of the individual served to be used for treatment planning purposes.
The practice parameters are an important resource for providers and caregivers alike in assuring quality of care. In addition to the information highlighted above, they offer guidelines for assessing risk, obtaining informed consent for telehealth, and more. Providers can reference this information when evaluating ethical and other considerations of telehealth services. The manual also serves as a tool for individuals, parents, and caregivers to better understand what to expect in ABA sessions delivered via telehealth and the associated outcomes of treatment. It can also prompt questions that families can ask their provider to learn how industry standards of evidence-based practice will be applied in their telehealth service delivery.
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How It Works at AnswersNow

AnswersNow offers telehealth ABA services on a continuum of care ranging from caregiver guidance only to direct care involving various levels of caregiver involvement, depending on the needs of the individual and family served.

During our intake process, a telehealth screening tool based on CASP guidelines is utilized with an individual and their caregiver(s) to determine appropriateness of fit before proceeding with treatment. We have a large network of state-licensed and Behavior Analysts (BCBAs), which represent a variety of clinical specialties. AnswersNow is a Behavioral Health Center of Excellence (BHCOE) - accredited provider and is currently in network with various insurance carriers in the states of Virginia and Georgia, including Medicaid. 

If you are curious how AnswersNow ABA may be able to help you or a loved one in need of care, reach out to us to speak with a clinician today by clicking here.

References

The Council of Autism Service Providers. (2021). Practice Parameters for Telehealth-implementation of Applied Behavior Analysis (2nd ed). https://casproviders.org/practice-parameters-for-telehealth/

Barretto A, Wacker DP, Harding J, Lee J, Berg WK. Using telemedicine to conduct behavioral assessments. Journal of applied behavior analysis. 2006; 39(3):333-340.

Ferguson J, Craig EA, Dounavi K. Telehealth as a model for providing behavior analytic interventions to individuals with autism spectrum disorder: A systematic review. Journal of autism and developmental disorders. 2019; 49(2):582-616.