Telehealth: Welcome to the Future.


Is Telehealth ABA here to stay post-pandemicOr should we wave goodbye to a solution that solved many problems when COVID first hit? What does the future of ABA look like?

Well, definitely across many other industries: Hybrid or Remote work is here to stay.

As COVID continues...and continues, now is the time to start looking ahead and considering where Telehealth belongs in the world of ABA. Front and center? Or a "break glass in case of emergency" temporary solution?

During 2020, many of us relied on remote services and/or technology to teach our kids, bring our groceries, attend professional conferences, receive doctor check ups, or check in on family and friends. Video calls became a way of life. ABA therapy was not exempt from that reality.

But many ABA companies that were forced to embrace Telehealth during the height of the pandemic are now starting to look into moving away from Telehealth, re-opening clinics at full capacity, going back to school based services, and reintroducing group therapy formats (such as social skill groups). Carefully, of course, and while following local and state level mandates.

I see lots of discussion and news content focused on should ABA Telehealth continue for clients (Is this the best decision for the clients). But little focus on "What about for the professionals?". Do ABA providers have a preference between Telehealth services and non-Telehealth services?

The answer to that question may vary according to comfort level/familiarity with technology, age of client/populations served, and the specific ABA provider. RBT's may be less comfortable with Telehealth than BCBAs. Or, vice versa. There are pros and cons on both sides of this issue, but the main takeaway here is this type of clinical decision needs to be made with all parties involved. And that includes the professionals/providers, not just company owners/employers, or clients and client families.

First, let's clarify what is meant by Telehealth:

Telehealth ABA services are provided virtually through HIPAA compliant means, usually a combination of video and audio that occurs live-time during the session. Typically, funding or clinical need is most appropriate for Telehealth BCBAs. While RBTs can work virtually as appropriate for the client, funding does not always allow for this.

Telehealth typically is utilized for homebased services, although clinic or school based providers can utilize Telehealth as well.

Virtual service delivery already has a long, established history in other fields such as Mental health counseling, Psychological services, and Medicine. Telehealth is not new. However, the field of ABA embracing Telehealth IS fairly new. Prior to COVID, many insurance funders did not even have billing codes for Telehealth services.

At the BCBA level, all service delivery can utilize Telehealth (as appropriate for the particular client), including assessment, parent support, and RBT supervision.

So why the pushback against Telehealth? Why do some funding sources, employers, or practitioners seem so against Telehealth? Well, sometimes Telehealth is applied with a broad brush to clients it may not be appropriate for. I know of clinicians who are currently very anti-Telehealth because of how they've seen it done, or having it thrust it upon them at work with little to no training or support. If you are a BCBA who hates Telehealth, did anyone take the time to train you on its use? Do you have someone to reach out to with troubleshooting and questions? If you are a RBT who hates Telehealth, was it explained to you at the onset of the case? Did you know going in the BCBA would not be on-site with you? Its important to separate personal bias and preference from the use of technology to provide services. Just because you do not like Telehealth, does not mean its all bad.

When utilized in an evidence based and ethically sound ways, Telehealth has numerous benefits. I have been utilizing Telehealth to service families since 2010. If it had not been an option, these families may have gone without help and assistance. For international or rural families, professional help may not be located up the street. It may be located in a different state, or country.

Telehealth allows me to clinically supervise in discreet, non-disruptive ways that minimize client reactivity. It allows me to easily hold progress meetings with client families who may not be available during scheduled therapy sessions. I can have a 20 minute videocall with a client's dad while he's on his lunch break at work. Trying to do that in person/on-site would present many logistical challenges. 

Telehealth allows me to work for a living while also being home to support my OWN family, during this pandemic craziness. I have a few close friends who are new moms, and if they did not have the option to work via Telehealth through their maternity leave and beyond, they would have been left with no choice other than resigning from their positions.

Lastly, I think the largest benefit of Telehealth ABA services may be explained in this data:

  • United States – 1996 BCBAs in the state of MA
  • United States – 107 BCBAs in the state of Nebraska
  • United Kingdom – 321 BCBAs  
  • Australia – 111 BCBAs 
  • United Arab Emirates – 104 BCBAs
  • Russian Federation – 33 BCBAs
  • India – 27 BCBAs
  • Spain – 26 BCBAs
  • Brazil – 10 BCBAs
  • Nigeria – 1 BCBA

These numbers are a very sober reminder that Telehealth is not just about personal preference, pandemics, or open-minded employers. As the demand for ABA continues to grow, the supply is not keeping up. We have far more people in need of service, than qualified providers available to help.

Telehealth makes it possible for 1 BCBA to service clients who may live in different zip codes, states, or countries. It helps companies with dire staffing deficits open up their services to more clients, it helps RBT's in dire staffing areas receive clinical support and BCBA help, and it attracts (and possibly retains) BCBAs located out of area. 

Gone are the days where the ABA provider needs to spend 7 hours in their car crisscrossing the city to see 3 clients. Now with Telehealth, not only can those 3 clients be seen WITHOUT traffic jams, but the provider could add on more clients in the same day. Removing the commute means staff spend more time working, and less time sitting in traffic (aka increased productivity). 

Opening up Telehealth services means getting families off of waiting lists, and starting up services. No more waiting months to locate and hire a BCBA in the area.

Also, sickness/illness: What about minor but still contagious illnesses, such as pink eye, stomach virus, strep throat, rashes, etc.? The provider doesn't need to cancel the session when they can just implement Telehealth instead.

What about when staff move out of area? Instead of losing quality providers, forcing the family to accept the transition, and disrupting care, how about the BCBA remains on the cases via Telehealth?

Just being able to offer Telehealth/work from home as an option to employees/staff means being a more open-minded, accommodating, and future focused employer. It is attractive to applicants when a work setting provides options. 

Again, Telehealth may not be the appropriate choice for every client or family. But, when appropriately utilized Telehealth can make the job of the ABA clinician easier and more efficient. And what employer isn't a fan of efficiency? ;-)

*Further Reading/Resources:

What does Telehealth ABA Look Like?

Telehealth for Children with Disabilities

Telehealth ABA - Best Practices

Moving Forward while Staying Home 

Practical Guidelines for Telehealth ABA

Therapy During COVID 19

Telehealth: Challenges & Solutions

Rapid Conversion from Clinic to Telehealth ABA 

Guidelines for TelePsychology 

Guidelines for Telehealth Related Ethics

Is Telehealth ABA Here to Stay?

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