Reaching Rural, Underserved, and Low-resource Communities. Clarksville. Cookeville. Knoxville. Nashville. Chattanooga
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1 Telepractice to Increase and Improve Access to Diagnostic and Early Intervention Services for Children in Rural, Underserved, and Low Resource Communities A. Pablo Juárez, M.Ed., BCBA Director, Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) Vanderbilt Kennedy Center Behavior Analyst in Pediatrics; Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Reaching Rural, Underserved, and Low-resource Communities Memphis Jackson Clarksville Nashville Cookeville Chattanooga Knoxville How do we: 1) provide high quality services in rural, underserved, and low resource communities, while 2) optimizing efficiency & innovation within sustainable programs, which 3) are embedded within existing systems of education, medicine, care? Tri-Cities 1
2 Early Identification and Intervention TRIAD Early Intervention Suppor t West and Middle Tennessee 1. Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD Access Capacity 1. Traditional Dx / Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD 2
3 Early Intervention Services Telepractice and Caregiver Training / Provider Consultation Caregiver Training and Provider Consultation Psych. BCBA/LBA, Psychologist, SLP, BCaBA, RBT OR ASD Evaluation Curriculum Module Local Interventionist Mentorship ~3-4 Weeks ~6-8 Weeks 6-months or age-out 3
4 Case Example: Brittany Case Example: Brittany Service Outcomes Caregiver Fidelity Communication Social Play Challenging Behavior Middle West Caregivers can approach fidelity in 6 visits 4
5 WEST 1 = Very Much Improved MIDDLE Service Outcomes Social Validity Service Outcomes - Family Functioning Service Outcomes Global Measures 4 Caregiver = 2.7 Satisfaction with 3 2 Service Model Satisfaction with Consultant Usefulness of the Service Outcomes of the Consultant = 2.5 Caregiver = = Very Much Worse 1 Service Middle West Social validity and impact on perceived behavior is high Caregivers report slight increases in family functioning. Consultant = 2.5 Improvements in global measures of child functioning. 5
6 Walther Telediagnostic Feasibility/Validation Study Room 1 Room 2 Telediagnostic Evaluation Family + Assessor Psychologist 1 (Private Office) Traditional Evaluation Family + Psychologist 2 Results/Details, N=20 75% diagnosed with ASD via telediagnostic evaluation Forced binary choice 75% certainty 95% diagnosed with ASD via traditional evaluation 100% agreement on those diagnosed with ASD via telediagnostic evaluation 78.95% sensitivity Referrals/Evaluations to Metropolitan Addition of Telemedicine Tertiary Care Diagnostic Center (Metro.) Diagnostic Services (Telemed.) *Telediagnostic services began 8/8/ Referrals Metro. Evaluations Metro. Referrals Telemed. to at to Evaluations at Telemed. Total Referrals Total Evaluations Results/Details 89% increase in total referrals % decrease in referrals to Nashville (primary site) Comparison region had 114.7% increase in referrals to Nashville Remaining referrals to Nashville in 2017 primarily included medical complexity 15% Increase in overall show rates Cost savings ASD Evaluation + Intervention Sessions + Medical Consult Traditional Service vs. Telepractice Down Syndrome 6 Intervention Sessions Hobbs 6
7 West and Middle Tennessee 1. Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD Family Training Families First What: Free workshop for caregivers of young children newly diagnosed with ASD 1. Traditional Dx / Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD Program Goals: To equip caregivers with practical tools in areas most frequently requested following a diagnosis To provide resources to more easily apply strategy and planning ideas To give caregivers an opportunity to meet other caregivers with similar questions or concerns 7
8 Families First When: ~Monthly Duration: ~3-hours Where: *Vanderbilt Kennedy Center Who: Caregivers, Educators, Providers, all are welcome Extensions: Spanish-speaking *Live-stream locations Jackson, TN Chattanooga, TN Knoxville, TN TriCities, TN Bowling Green, KY Birmingham, AL Woodstock, GA Dallas, TX Albuquerque, NM Omaha, NE Wilmington, DE Opportunity: Vanderbilt Health Affiliate Network Technology Outpacing Ethical Discourse Laws and institutions must go hand in hand with the progress of the human mind. As that becomes more developed, more enlightened, as new discoveries are made, new truths disclosed, and manners and opinions change with the change of circumstances, institutions must advance also, and keep pace with the times. - Thomas Jefferson,
9 Our Team: Ethical Considerations of Telepractice Services Internet access Hardware Software Service location Service selection Consumer consent and capacity Addressing failure (and planning for it) Funding and sustainability of services Addressing Failure (and Planning For It) Proceed with YES Telepractice Can the technological issue Technology be addressed without sacrificing integrity? Consider alternative NO methods of service delivery Source of Failure Proceed with YES Telepractice? Are the alternatives Service Are there YES appropriate for Outcome other Telepractice? NO Consider assessments alternative or treatments Consider alternative methods of that could be NO methods of service service delivery used? delivery Special Thanks Collaborators: Tennessee Department of Education Tennessee Early Intervention System West Tennessee Health Ayer's Children s Clinic The King s Daughters School Bedford County Child Development Center VUMC Telemedicine Office Alacia Stainbrook, Ph.D., BCBA-D Neill Broadrick, Ph.D. Kristin Dorris. M.S., CCC-SLP Mary Fleck, M.Ed., BCBA LaTamara Garrett, M.Ed., BCBA Jeff Hine, Ph.D., BCBA-D Stephanie Kretzer, M.Ed., BCBA Marie Martinez, M.Ed., CCC-SLP, BCBA Mary Morton, M.Ed., BCBA Amy Nicholson, M.S., LPE McKenzie Peeler, B.S. Kathleen Simcoe, M.Ed., BCBA Amanda Spiess, M.Ed., BCBA Ashley Vogel, M.Ed., BCBA Zachary Warren, Ph.D. Amy Weitlauf, Ph.D. 9
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