Reaching Rural, Underserved, and Low-resource Communities

Transcription

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 1

2 Reaching Rural, Underserved, and Low-resource Communities Clarksville Tri-Cities Nashville Cookeville Knoxville Jackson Memphis Chattanooga 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? 2

3 3

4 Early Identification and Intervention 4

5 TRIAD Early Intervention Suppor t Access Capacity 5

6 West and Middle Tennessee 1. Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD 1. Traditional Dx / Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD 6

7 Early Intervention Services 7

8 Telepractice and Caregiver Training / Provider Consultation OR 8

9 Caregiver Training and Provider Consultation Psych. BCBA/LBA, Psychologist, SLP, BCaBA, RBT ASD Evaluation Curriculum Module Local Interventionist Mentorship ~3-4 Weeks ~6-8 Weeks 6-months or age-out 9

10 Case Example: Brittany 10

11 Case Example: Brittany 11

12 Service Outcomes Caregiver Fidelity Communication Social Play Challenging Behavior Middle West Caregivers can approach fidelity in 6 visits 12

13 Service Outcomes Social Validity 4 3 Satisfaction with Service Model Satisfaction with Consultant 2 Usefulness of the Service 1 Middle West Outcomes of the Service Social validity and impact on perceived behavior is high 13

14 Service Outcomes - Family Functioning Caregivers report slight increases in family functioning. 14

15 1 = Very Much Improved MIDDLE WEST 4/4/2018 Service Outcomes Global Measures Caregiver = 2.7 Consultant = 2.5 Caregiver = = Very Much Worse Consultant = 2.5 Improvements in global measures of child functioning. 15

16 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 16

17 Referrals/Evaluations to Metropolitan Tertiary Care Diagnostic Center (Metro.) Addition of Telemedicine Diagnostic Services (Telemed.) *Telediagnostic services began 8/8/ Referrals to Metro. Evaluations at Metro. Referrals to Telemed. 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 17

18 Walther 4/4/2018 ASD Evaluation + Intervention Sessions + Medical Consult Traditional Service Hobbs vs. Down Syndrome 6 Intervention Sessions Telepractice 18

19 West and Middle Tennessee 1. Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD 1. Traditional Dx / Telediagnostics + 2. Caregiver Training and Provider Consultation + 3. Provider PD 19

20 Family Training 20

21 Families First What: Free workshop for caregivers of young children newly diagnosed with ASD 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 21

22 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 22

23 Opportunity: Vanderbilt Health Affiliate Network 23

24 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,

25 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 25

26 Addressing Failure (and Planning For It) Technology Can the technological issue be addressed without sacrificing integrity? YES NO Proceed with Telepractice Consider alternative methods of service delivery Source of Failure Service Outcome Are there other assessments or treatments that could be used? YES NO Are the alternatives appropriate for Telepractice? Consider alternative methods of service delivery YES NO Proceed with Telepractice? Consider alternative methods of service delivery 26

27 Our Team: 4/4/2018 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. 27

28 Thank you Follow Us, Like 28