What Does Telehealth ABA Look Like- Parent Perspective

If your child was participating in any therapies before this global crisis began, those services likely transitioned to a telehealth model within the past 30 days or so.

Ideally, this process was explained to you, along with potential benefits vs risks, and you feel competent as a parent/caregiver to utilize this remote model of therapeutic intervention.

If not, you are the the reason for this post.

For far too many families, the decision to move to telehealth for ABA services was made for them, or presented as a "take it or leave it" option. This could be due to staffing issues (as more and more people are self-quarantining), more funders allowing for telehealth, or just the preference of the service provider. Maybe you are filled with anxiety and confusion as to how telehealth will be effective for your child. You may think your child is too young to benefit, or too old to benefit, or can't attend to a screen, or attends TOO much to a screen, etc.

Whatever your particular situation may be, I hope to help alleviate some of your concerns by providing an overview of Telehealth ABA.

Let's dive in...

Before our current quarantine reality, telehealth was being used quite effectively to provide ABA services to consumers in under served areas, to supplement in-person services, and to work with consumers internationally. I have also found benefit of telehealth when it comes to illness or travel (basically, being unavailable). If someone in the consumer home has a contagious illness, I can still support my client remotely using telehealth. Or if I am traveling for a professional conference, I can check in on my clients using telehealth. So even if you aren't currently a fan of telehealth, know that it does have benefit for many families.

To provide a definition, Telehealth is the use of communication technology to assist in education and treatment of health related conditions (Ferguson, Jenny et al. 2019).

Telehealth is not something to just jump into. Like any other therapeutic service, there are some foundational steps to complete first. Before beginning ANY telehealth therapeutic treatment, you and your service provider should be openly discussing the following:

1. Technology Capability - As a caregiver, how comfortable are you with using technology? Do you have access to reliable wi-fi? Do you have a quality web cam, camera, or cell phone to use for video chats or calls? Will you need to purchase a headset or microphone, or are your computer speakers fine to use? Do you have a scanner and printer, if needed? If not, who will help you get up to speed with technology?

2. Scheduling & Availability - Are there time zone differences to consider? What is your schedule of availability to virtually meet with the service provider? Does telehealth increase or decrease your availability? What time of day would work best for your child? Are they more likely to be attentive in the am or pm? Is the telehealth schedule being created based on what works for your household, or just when the service provider says they have time?

3. Caregiver Participation - Are your current stress and emotional levels at a point where you can do this? Has it been explained to you that telehealth may require an adult in the home assist with the session, for the duration of the session?  Do you know how to manage challenging behavior in the absence of the service provider being physically present? Do you understand how to provide reinforcement to your child, in the absence of the service provider being physically present? What will your other children be doing while you are assisting with the telehealth session? If you are also doing school at home right now, can you do both that and this?

4. Unique Client Needs - What does your child need in order to benefit from this? Visual supports? Token boards? If your child is very active and reinforced by physical touch or play, how will that happen virtually? Will it be upsetting or confusing to your child to see and hear the service provider, but they aren't physically there? Should the treatment goals be reduced for telehealth sessions? What abut the session length; can your child participate in a virtual 2 or 3 hour session? Will there be a Registered Behavior Technician (RBT) or direct therapist with you, as the Board-Certified Behavior Analyst (BCBA) joins in virtually? Or will it just be you and your child? Which is likely to be more effective?

There are 3 main services delivered by ABA providers: Supervision, Direct Service, and Family Support (commonly referred to as "parent training").
I will explain how each type of service could look using a telehealth format. Remember, the specific service that is selected for a telehealth modality should be decided by you and the service provider based on what would be most effective for your child. In other words, direct service via telehealth may not be a great idea, just depending on the specific needs of your child and the unique demands of your household.

  • Supervision is most often provided by the BCBA for a percentage of the hours the RBT or direct staff work with your child. Some providers may choose to have RBT's continue coming to your home, with the BCBA joining the session virtually. Other providers may have both the RBT and the BCBA conduct virtual sessions. There is no set answer to this, and it will vary by area and by provider. This is also a funding decision, as not all funders permit non-BCBAs to provide telehealth. In the event that you are only receiving services from a BCBA, they do not require supervision. However, RBTs and Board-Certified Assistant Behavior Analysts (BCaBAs) cannot practice independently.
  • Direct service is most often provided by the RBT or direct therapist. If the RBT you work with is able, in-person direct service can still occur with the BCBA supervising remotely. If not, the RBT and/or BCBA may provide direct service virtually. Depending on the unique circumstances of treatment, direct service may need to be modified for telehealth. For example, goals may need to be reduced or placed on hold temporarily, like goals that require peers or going into the community. Any issues with your child attending, leaving the instructional area/running off, or trying to hit/disrupt the video call equipment can be addressed with the BCBA. They will be able to tell you how to help your child benefit from telehealth services. Please note that direct service provided virtually will most likely require an adult in the home assist with the session as far as prompting, delivering reinforcement, managing challenging behavior, troubleshooting technical difficulties, etc.
  • Family support can occur with any parent or legal guardian, and will have specific goals and measurable outcomes. Family support can include your child, and it can also occur with just you and the BCBA (most funders only permit BCBAs to provide family support). Keep in mind that due to the virtual format, family support time may steal your attention and focus away from other household activities. For example, if the BCBA needs to virtually meet with you to review progress and discuss changes to the treatment plan, it may be unrealistic to try to do this as you simultaneously cook dinner or engage your other children. 

Depending on the specific service being delivered, the amount of upheaval and stress in the client household, the current functioning of your Autistic child (will telehealth work for them??),  and caregiver ability to fully participate, telehealth can be more or less beneficial to families.
And that is OKAY.

You are not required to continue therapy services in the midst of a global pandemic. Think about the pros vs the cons, and make the best decision you can for your family.

*Resources & Further Information:

ABA Parent Training using Telehealth

Behavior Babe

Central Reach

Benefits of Telehealth

ABA Parent Training via Telehealth video 1, and video 2 

Podcast: ABA services in a global pandemic

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