The oft-cited statistic that one out of every 68 children in America has autism spectrum disorder (ASD) serves as the ongoing reminder that ASD affects many families, school systems and communities. The challenge for the health care system at large is to determine the best treatment at a cost society can bear.
That’s where ABA – Applied Behavior Analysis – comes in. In brief, ABA is an intensive behavioral skill-development treatment that specifically focuses on shaping developmentally appropriate skills and decreasing maladaptive behaviors. ABA can be one-on-one or in groups. Using positive reinforcement, board-certified behavior analysts (BCBAs) and the paraprofessionals they supervise deliver this service most often in a home setting, as well as in classrooms and natural community settings, i.e., managing the distractions of shopping in a retail store to prevent a breakdown. Evidence reveals ABA to be the established best practice of ASD treatment: compared to other treatment modalities, children achieve more with less.
It is a problem that telehealth can address, and has done so successfully by ensuring children receive ABA services sooner and faster – thereby increasing treatment efficacy – and at a lower cost.
However, as with many types of care, access to ABA treatment is problematic for those people living in rural or underserved areas. As it stands, there is a dearth of ABA therapists across the country, a problem further exacerbated in remote communities. Fortunately, it is a problem that telehealth can address, and has done so successfully by ensuring children receive ABA services sooner and faster – thereby increasing treatment efficacy – and at a lower cost.
Case in point
A 3-year-old boy with ASD and a Beacon Health Options member lives in Washington’s Puget Sound area, whose family was struggling to find ABA services for him. It turns out that his preschool teacher agreed to be his ABA paraprofessional under certain conditions, which is where telehealth, Beacon and a BCBA come together.
Comparing in-home therapy, clinic-based telehealth, and home-based telehealth, one 2016 study found that while all three methods resulted in improved behavior outcomes, total treatment costs were lowest for home telehealth.
Using synchronous video conferencing that is HIPAA-compliant, Beacon located a lead BCBA who supervises the preschool teacher providing the direct ABA outside of school hours. Additionally, the lead Seattle-based BCBA supervises home-based training for the boy’s parents through video conferencing. In addition to this parent training and supervision, the BCBA also developed a treatment plan for the young boy, to be modified and adjusted, as his needs change. Because of this three-pronged approach to care, the child has made excellent progress in the last 18 months, achieving improvement across a wide range of skills. His problematic behaviors decreased as well.
The success of telehealth and ABA services is more than anecdotal; the data bear out its success as well. Comparing in-home therapy, clinic-based telehealth, and home-based telehealth, one 2016 study found that while all three methods resulted in improved behavior outcomes, total treatment costs were lowest for home telehealth, while both telehealth models were significantly less costly than in-home therapy.
Telehealth is also successful in training parents. Another study, involving seven parents of children with ASD, revealed that these parents increased their knowledge of ABA strategies by 39 percent and improved implementation of those strategies by 41 percent. Additionally, a total of 9,052 driving miles were saved across the four families. Indeed, Beacon calculates that telehealth has the potential to make lead analysts up to 50 percent more productive with less time in traffic, tolls and travel time in rural areas.
A good start but more to do
Because of the success in addressing the very real issue of treatment access, Beacon is working to increase the availability of telehealth ABA services for its members. Already, the behavioral health management company has ABA telehealth contracts with several Medicaid plans and employers and is expecting to increase that number in the months ahead.
With April as National Autism Awareness Month, there is no time like the present to reflect on how we can make ASD treatment even better – more accessible, more effective and more affordable. Telehealth has an important role to play in doing so, and Beacon calls upon all stakeholders – including policymakers in those states that place restrictions on telehealth – to work together to make an evidence-based practice industry best practice.
