Maintaining Treatment Integrity in the Face of Crisis: A Treatment Selection Model for Transitioning Direct ABA Services to Telehealth

Abstract

With health care funders' increasing approval of telehealth service as an emergency measure to provide continuity of care during the COVID-19 crisis, practicing behavior analysts have an unprecedented opportunity to demonstrate that essential, medically necessary behavior-analytic services can be provided via telehealth in a manner that maintains treatment integrity and produces meaningful client outcomes. This telehealth treatment selection guide was designed to assist practicing behavior analysts in determining an appropriate protocol for the delivery of 1:1 telehealth service (i.e., a behavior technician providing instruction directly to a client, with or without the assistance of the client's caregiver, through videoconferencing). This tool aims to help behavior analysts make thoughtful clinical decisions to maintain continuity of care for the vulnerable population with autism spectrum disorders, while adhering to safety measures that provide protection to society. Keywords COVID-19. social distancing. telehealth. treatment integrity At the time of publication of this article, a global pandemic (COVID-19) has necessitated drastic changes to societal structures the world over: Entire states, provinces, and even countries have been placed under government orders for citizens to remain at home, allowing only essential services to continue. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have released guidance on community mitigation strategies (CDC, n.d., WHO, 2020); limiting close social contact (i.e., social distancing) has previously been identified as critical to slowing the spread of pandemics and is ultimately expected to save countless lives (CDC, 2017). In the United States, a national state of

Evaluating discrete trial teaching with instructive feedback delivered in a dyad arrangement via telehealth

“…Thus, although participants engaged in behaviors consistent with a bidirectional naming repertoire, overt echoics did not occur at high rates consistently across trials or sessions. Rodriguez (2020) suggested assessing client's attending, responsiveness to prompting, and frequency and intensity of challenging behavior to determine if a client would be appropriate for direct telehealth services. Participants in this study demonstrated high levels of attending during teaching trials (i.e., 93.8-100% per session), responded to vocal corrective feedback, and did not engage in frequent challenging behavior.…”

“…Depending on the child's repertoire, some behavior analysts and their supervisees are implementing clinical sessions directly with the child via Zoom™ or other video-based telecommunication platforms. That is, staff are conducting sessions virtually with the child, not necessarily training parents or another interventionist to implement behavior analytic procedures (Rodriguez, 2020).…”

“…Considerations that may be important for learner success in this format are the client's attending skills, basic joint attention skills, basic echoic skills, ability to follow one-step instructions, responsiveness to distance prompts, and level of problem behavior (Council of Autism Service Providers, 2020; Rodriguez, 2020). This new practice of directly providing intervention through video conferencing technology differs from the currently available behavior analytic research on telehealth.…”

Changes in access to educational and healthcare services for individuals with intellectual and developmental disabilities during COVID‐19 restrictions

“…In this model, an expert 'hub' provides consultation about patients to providers ('spokes') through videoconferencing, empowering the local physicians to effectively care for complex patients (Arora et al 2011;Mazurek et al 2016). Efforts to provide targeted guidance for professionals working under these conditions are now being developed (Rodriguez 2020).…”

Video Self-Modeling for a Student with Dravet Syndrome: an Intervention Involving Parents During Covid-19 Pandemic in Italy

“…Therefore, professionals have started to evaluate the feasibility and opportunity of a transition, at least temporarily, towards telehealth services to provide behavior analysis services. The therapist provides instructions to the client through the use of video-conferencing systems (Rodriguez, 2020).…”