A Study of Occupational Therapy Telehealth Coaching for Families of Children with Autism

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1 A Study of Occupational Therapy Telehealth Coaching for Families of Children with Autism This whitepaper summarizes the findings from a study of telehealth occupational therapy (OT) for families of young children with Autism Spectrum Disorders (ASD) in underserved communities. The researchers (Little, Dunn, Pope, & Wallisch) studied the cost-effectiveness of telehealth OT, its effectiveness in achieving parent and child goals, and how satisfied parents were with the intervention approach. The study was funded by the American Occupational Therapy Foundation. What is Telehealth Occupational Therapy? Telehealth is a delivery model for providing health-related services from a separate location by using telecommunication technology. It includes the application of evaluation, preventative, diagnostic, and therapeutic services via two-way or multipoint interactive telecommunication technology. 1 1

2 Why Telehealth? The rate of ASD diagnosis is increasing, whereas the resources to provide OT are decreasing 2. Telehealth allows occupational therapists to reach a higher number of families without increasing costs. In fact, one study showed that 87% more children may receive services without increasing costs by using a telehealth service delivery model 3. Additionally, many underserved families of children with ASD have difficulty accessing OT services, which may have a negative impact on child development and family outcomes over the long term 4. Therefore, telehealth may be particularly beneficial to provide services to families that are considered underserved (i.e., rural, lower socioeconomic status, racial/ethnic minorities). What about the content of the intervention? Can occupational therapists effectively provide intervention using teleconferencing? Coaching was recently identified by the American Academy of Pediatrics as a best practice method in early intervention 5. The current study used Occupation Based Coaching (OPC), which focuses on directly working with caregivers to increase children s participation in everyday activities and build family capacity. Occupation based coaching is comprised of many elements 6, which include: (1) Authentic Contexts (2) Family s interests and routines (3) Caregiver Interaction and Responsiveness (4) Parent Reflection and Therapist Feedback (5) Joint Plans What were the findings of the study? Acceptability. The study included 18 families of children with ASD ages 2-6 years 7. Using an acceptability questionnaire, the parents reported that they were high satisfied with the use of telehealth, or talking with occupational therapists over the computer. Parents also reported that the content of the intervention was highly effective for their child 8. This program was so nice in order to be at home rather than making an appointment outside of home. 2

3 Parent Efficacy. Parent efficacy is hypothesized to be the active ingredient in coaching; parent efficacy pertains to how effective the parents feel in implementing strategies and problem solving through difficult situations. Using the Parent Sense of Competence Scale 9, researchers found that parent efficacy significantly increased postintervention, t(16)=2.529, p=.022; Cohen s d=.35. The OT gave me the confidence to help me find that my instincts in what techniques worked for my daughter were spot on. I now feel so confident and empowered. Child Participation. Child participation was also measured pre- and post-intervention using the Assessment of Preschool Children s Participation 10, Canadian Occupational Performance Measure 11, and Goal Attainment Scaling. Research found: Play frequency was found to have significantly increased (p<.005). That is, parents played with their children more often post-intervention. Skill development diversity significantly increased (p<.05). That is, parents engaged their children in more activities that targeted skill development, such as playing with puzzles, helping with chores, reading books, and building things. Parent identified goals significantly increased, with regard to both performance and satisfaction (p<.001, respectively). Parent identified goals included child toilet training, mealtime behavior, and community safety. Telehealth is a promising method of OPC delivery for families of young children with ASD, particularly for underserved families. When parents have the support of an occupational therapist to identify strategies that increase child participation in everyday activities, they likely feel increasingly effective in their parenting role. 3

4 Is Telehealth Occupational Therapy Cost-Effective? Researchers studied the costs associated with telehealth OT sessions versus sessions held in families homes or at a clinic. Transportation time and costs for both occupational therapists and families was one of the biggest savings of using telehealth. Particularly in rural communities, travel times can reach greater than one hour each way. Although travel burden and time vary by intervention delivery model, researchers used family and therapist costs and found the following: Each outpatient session costs approximately $ Each in-home session costs approximately $ Each telehealth session costs approximately $ Outpatient therapy can cost the family an average of $4, per year in travel and time alone. Based on the average income of study participants, this results in an 11% loss of family income per year. As the number of children with ASD increases, the use of telehealth to provide OT services appears to be a promising method that is efficacious and cost-effective. Interested in learning more about telehealth? Here are a few resources: American Telemedicine Association - Telerehabilitation Special Interest Group Center for Telehealth and e-health Law AOTA Telehealth Resources 4

5 References: 1. Cason J. Telehealth and occupational therapy: Integral to the triple aim of health care reform. American Journal of Occupational Therapy. 2015; 69(2): p p8. 2. Wise MD, Little AA, Holliman JB, Wise PH, Wang CJ. Can state early intervention programs meet the increased demand of children suspected of having autism spectrum disorders? Journal of Developmental and Behavioral Pediatrics. 2010; 31(6): Cason J. A pilot telerehabilitation program: Delivering early intervention services to rural families. 2009; 1(1): Durkin MS, Elsabbagh M, Barbaro J, et al. Autism screening and diagnosis in low resource settings: Challenges and opportunities to enhance research and services worldwide. Autism Research. 2015; 8(5): Adams RC, Tapia C, Murphy NA, et al. Early intervention, IDEA part C services, and the medical home: Collaboration for best practice and best outcomes. 2013; 132(4): e1073-e Dunn W, Little LM, Pope E, Wallisch A. Establishing fidelity of occupational performance coaching. OTJR: Occupation, Participation and Health. 2017: Little, LM, Pope, E, Wallisch, A, Dunn, W. Occupation based coaching via telehelath for families of young children with autism spectrum disorders. American Journal of Occupational Therapy. In press. 8. Little, LM, Wallisch, A, Pope, E, Dunn, W. Cost-effectiveness of a telehealth intervention for families of children with autism. Under review. 9. Johnston C, Mash EJ. A measure of parenting satisfaction and efficacy. 1989; 18(2): Petrenchik T, Law M, King G, Hurley P, Forhan M, Kertoy M. Assessment of preschool children s participation Law M, Baptiste S, Carswell-Opzoomer A, McColl MA, Polatajko H, Pollock N. Canadian occupational performance measure. 2nd ed. Ottawa, Ontario: CAOT Publication; PearsonClinical.com Copyright 2017 Pearson Education. All rights reserved. Pearson is a trademark, in the US and/or other countries, of Pearson Education, Inc. or its affiliates. CLINA EL 11/17