A Behavioural Education Initiative
With advances in medicine and healthcare, also came the advances in the use of technology in delivering essential services in healthcare. The United States Board on Health Care Services (2012) has mentioned that virtual supervision or consultation regarding health, bridge the gap for those people who do not have access to physical or face to face delivery of services. The concern that these address, in many ways, is access to services for the people who need these services the most. Apart from eliminating barriers to access, virtual or remote supervision of ABA programs and to a large extent, tele-therapy, allow the professionals and practitioners to establish a more plausible and seamless continuity of care, despite constraints.
In the field of Behaviour Analysis, some studies have already found how promising virtual or distance supervision could be, not just in terms of access but in terms of carrying out the main aims of the practitioners in the field from assessment to intervention, without sacrificing the use of evidence-based practices. The studies show some promising results in enhancing evidence-based practice through the use of agents, such as parents, caregivers and teachers to further and deliver the instruction and intervention. Furthermore, apart from addressing the problem of access to behaviour analytic services, virtual, distance or remote supervision also lowers the cost of services, as cost and travel expenses were considerably lower than in-person services (Tomlinson et.al., 2018).
In terms of assessment, some studies have concluded that many forms of indirect and direct assessments, even functional analyses can be conducted successfully through distance supervision (Baretto et. al., 2016; Boisvert et. al., 2010; Wacker et.al., 2013a); . For example, Wacker, et. al. (2013a) have reported that through prior parent training and inter-rater agreement, functional analyses done through remote supervision proved to be successful among 18 out of 20 participants or children from rural areas who participated in their study.
In terms of intervention, a few studies have shown that intervention, introduction and service delivery through telehealth or distance supervision, may prove to be effective and successful by teaching or training agents to deliver the program effectively (Barkaia et. al, 2017; Boisvert et. al., 2010; Wacker et.al. (2013b). For example, Wacker et al (2013b) conducted a Functional Communication Training (FCT) program to reduce problem behaviour among young children diagnosed with autism spectrum disorder. The children and families who participated in the program are on the average, located 222 miles from regional clinics or centres which are offering intervention. In this study, parents received briefings from experienced Behaviour Analysts prior to implementing an FCT program. The results of the study mentioned that there are about 93.5% reduction of problem behaviours after implementing the FCT program with the participants. The study claims that FCT can be conducted by parents via telehealth, effectively when there is consultation with an experienced Behaviour Analyst.
The parent, caregiver or teacher training component to makes virtual or remote supervision in Behaviour Analysis successful cannot be undermined. In the experience of Learning through ABA, virtual or remote supervision enhance not just agent or parent training but more significantly, (1) strengthens parent-child relationships through stimulus-stimulus pairing (parent, caregiver or teacher as the implementer of the reinforcement process), thereby fostering that positive social relationship and (2) may help in broadening the learner’s repertoire and application of skills in more generalized and natural environment settings, i.e. in their own homes and communities.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20(4), 313–327. https://doi.org/10.1901/ jaba.1987.20-313.
Barkaia, A., Stokes, T. F., & Mikiashvili, T. (2017). Intercontinental telehealth coaching of therapists to improve verbalizations by children with autism. Journal of Applied Behavior Analysis, 50(3), 582–589. https://doi.org/10.1002/jaba.391.
Barretto, A., Wacker, D. P., Harding, J., Lee, J., & Berg, W. K. (2006). Using telemedicine to conduct behavioral assessments. Journal of Applied Behavior Analysis, 39(3), 333–340. https://doi. org/10.1901/jaba.2006.173-04
Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov 20. 3, The Evolution of Telehealth: Where Have We Been and Where Are We Going? Available from: https://www.ncbi.nlm.nih.gov/books/NBK207141/
Boisvert, M., Lang, R., Andrianopoulos, M., & Boscardin, M. L. (2010). Telepractice in the assessment and treatment of individuals with autism spectrum disorders: A systematic review. Developmental Neurorehabilitation, 13(6), 423–432. https://doi.org/10.3109/17518423.2010.499889.
Lee, J. F., Schieltz, K. M., Suess, A. N., Wacker, D. P., Romani, P. W., Lindgren, S. D., et al. (2015). Guidelines for developing telehealth services and troubleshooting problems with telehealth technology when coaching parents to conduct functional analyses and functional communication training in their homes. Behavior Analysis in Practice, 8(2), 190–200. https://doi.org/10.1007/s40617- 014-0031-2.
Tomlinson, S. R. L., Gore, N., & McGill, P. (2018). Training individuals to implement applied behavior analytic procedures via telehealth: A systematic review of the literature. Journal of Behavioral Education, 27(2), 172-222. doi:http://dx.doi.org/10.1007/s10864-018-9292-0
Wacker, D. P., Lee, J. F., Dalmau, Y. C. P., Kopelman, T. G., Lindgren, S. D., Kuhle, J., . . . Waldron, D. B. (2013a). Conducting Functional Analyses of Problem Behaviour via Telehealth. Journal of Applied Behavior Analysis, 46(1), 31-46. Retrieved from https://search.proquest.com/docview/1351567376?accountid=166077
Wacker, D. P., Lee, J. F., Yaniz, C. P. D., Kopelman, T. G., Lindgren, S. D., Kuhle, J., . . . Waldron, D. B. (2013b). Conducting functional communication training via telehealth to reduce the problem behavior of young children with autism. Journal of Developmental and Physical Disabilities, 25(1), 35-48. doi:http://dx.doi.org/10.1007/s10882-012-9314-0
The following is the task list of outcomes to pursue the 'A PIE' process:
Initial Discussion through an online meeting about the details of Virtual ABA Program Supervision
Sign-up and/or Registration
Assessment (Initial and every sixth month thereafter)
Continuous Assessment and Evaluation while Intervention is taking place