Using this article: Pollard, J. S., LeBlanc, L. A., Griffin, C. A., & Baker, J. M. (2021). The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis.Journal of applied behavior analysis,54(1), 87-102.https://doi.org/10.1002/jaba.803

Summarize the main points in a short paragraph form then relate to telehealth. I am on the con side of the resolution "Telehealth technology threatens the future of Special Education & ABA," you're arguing against the idea that Telehealth is a threat meaning you're saying telehealth is beneficial and does not threaten the field. Here is some of the key information below just in case you need it.

Abstract:

Telehealth delivery of applied behavior analysis treatment has focused on supervision or staff and parent training, rather than the direct delivery of treatment to clients. The novel coronavirus (COVID19) crisis had the potential to significantly disrupt access to direct treatment for individuals with autism. We report a sample of 17 cases that transitioned from inperson to telehealth delivery of treatment when shelterinplace orders were issued. Of these cases, 76% of participants transitioned to techniciandelivered telehealth services whereas the rest transitioned to a caregiverimplemented telehealth model. Participants continued to access a similar dosage of treatment hours per week in spite of the treatment model transition (inperson M = 12; telehealth M = 11) and maintained or improved correct independent responding across all targets from inperson treatment (M = 75%) to telehealth treatment (M = 80%). These findings provide initial evidence that some clients with autism benefit from techniciandelivered telehealth services.

Telehealth is defined by the Health Resources and Services Administration as the "use of electronic information and telecommunication technologies to support and promote longdistance clinical health care, patient and professional healthrelated education, public health and health administration" (Health Information Technology, 2017, para 1). Importantly, telehealth is a means of delivering health care services rather than a distinct or separate healthcare service. This unique means of service delivery allows providers to deliver the healthcare service directly to the client without requiring the client to travel to receive care. Provider travel time to deliver care is also reduced, thus overcoming barriers such as geographic isolation and limited access to qualified professionals (Lerman et al., 2020; Pollard et al., 2017; Rispoli & Machalicek, 2020).

Telehealth has been employed for almost two decades in the delivery of applied behavior analytic (ABA) assessment and treatment services (Tomlinson et al., 2018). Individuals with autism spectrum disorders (ASD) and intellectual and developmental disabilities (IDD) have benefited from the use of telehealth to train caregivers and staff in the assessment and delivery of ABA services (Barretto et al., 2006; Boisvert et al., 2010; Ferguson et al., 2019; Fisher et al., 2014; Lindgren et al., 2016; Tomlinson et al., 2018; UnholzBowden et al., 2020; Vismara et al., 2009). A growing scientific evidence base indicates that some treatment services can be delivered directly to clients via telehealth using synchronous (i.e., realtime) videoconferencing technology (Ferguson et al., 2020; Myers et al., 2017; Pellegrino & DiGennaroReed, 2020) and that parents and staff can be trained via telehealth to deliver services to clients inperson (Bearss et al., 2018; Benson et al., 2018; Higgins et al., 2017; Monlux et al., 2019; Suess et al., 2014; UnholzBowden et al., 2020).

The most common version of telehealth services represented in the published literature is a caregiver telehealth coaching model, which involves a clinician providing training via synchronous videoconferencing to another person (e.g., parent, teacher, technician) at a distant site to deliver services inperson to the client (Council of Autism Service Providers [CASP], 2020a; Lerman et al., 2020). This model has been used for functional behavior assessments (Barretto et al., 2006; Benson et al., 2018; Boisvert et al., 2010), preference assessments (Higgins et al., 2017), behavior reduction procedures (Hall et al., 2020; Lindgren et al., 2016; Monlux et al., 2019; Suess et al., 2016; Suess et al., 2020; UnholzBowden et al., 2020; Wacker et al., 2013a; Wacker et al., 2013b), and interventions to build language, social, and daily living skills (Akemoglu et al., 2020; Barkaia et al., 2017; Ferguson et al., 2019; Ingersoll et al., 2016; McLay et al., 2020; Wainer & Ingersoll, 2015). A telehealth model commonly applied in clinical settings is a partial inperson telehealth modelwhereby ABA services are rendered inperson by a trained technician, with clinical oversight provided by a behavior analyst via realtime, synchronous videoconference modality (CASP, 2020b).

Two recent studies explored a techniciandelivered telehealth service model of ABA services, during which the individual clients participated independently in session without caregiver support via synchronous videoconferencing technology (Ferguson et al., 2020; Pellegrino & DiGennarroReed, 2020). That is, the participants received all instructions, prompting, and reinforcement from the provider via realtime videoconferencing technology. Pellegrino and DiGennarroReed (2020) evaluated the efficacy of total task chaining with leasttomost prompting delivered via videoconference to two adults with IDD. Both individuals were living semiindependently in housing for individuals with IDD. The targeted skills (e.g., cooking, managing a budget) were endorsed by the participants as interesting and relevant to their personal goals. The instruction involved vocal and model prompting, and these prompts were all delivered remotely. Both participants met the mastery criterion for each skill in fewer than 15 sessions. Notably, both participants expressed satisfaction with the goals, procedures, and effects of the intervention. Ferguson et al. (2020) used synchronous videoconferencing to teach tact relations to six children diagnosed with ASD, aged 3years 11months to 7years 1month. The experimenters taught participants in a dyad arrangement using discrete trial teaching procedures. All participants acquired the targeted skills and maintained responses 9days following training. The results of these studies are promising for the delivery of ABA treatment via synchronous telehealth modalities with both children and adults with ASD and DD.

The novel coronavirus disease (COVID19) pandemic and the subsequent containment measures led to unprecedented challenges to continued access to ABA treatment services for individuals with ASD and IDD (CASP, 2020a,b; LeBlanc et al., 2020; Megan, 2020; Wolfram, 2020). Federal, state, and local governments enacted emergency measures in response to the rapid outbreak of COVID19 to slow the spread of the disease. The U.S. government issued a national state of emergency and many states followed suit, implementing shelterinplace restrictions. Although the experimental literature on telehealth delivery of direct ABA services is sparse, the abrupt threat to services and risk for inperson contact during the COVID19 crisis created the need, as well as the opportunity, to explore and evaluate the viability of treatment services delivered directly to clients via telehealth.

To that end, the purpose of this study was to conduct an archival analysis of data collected during the transition from inperson direct services with telehealth clinical direction to a direct intervention telehealth model by an ABA provider agency during the COVID19 pandemic. Use of existing data affords researchers the opportunity to study natural events, has the advantage of reducing threats to internal validity such as experimenter bias, and can indicate the generalizability of results. Therefore, we used this archival data to a) examine client progress in skill acquisition programs before and after the transition, b) examine whether various skills were associated with differential success in this direct telehealth model, and 3) stimulate future research on techniciandelivered telehealth service delivery in ABA treatment.

Method

Organization and Provider Information

Ten Board Certified Behavior Analysts (BCBAs) providers from the same ABA organization contributed data to the sample of 17 client participants. That ABA organization had specialized in providing services under a partial inperson telehealth model for the past 6years. All BCBA clinicians were trained to provide clinical direction via a synchronous telehealth modality to Registered Behavior Technicians (RBTs) who were delivering inperson ABA services prior to COVID19. The clinicians and the RBTs had been employed for varying lengths of time at the organization (see Table 1 for provider experience information). The BCBAs were certified for an average of 54months (range, 21 101months) and had worked at the organization providing supervision via synchronous telehealth for an average of 19months (range, 0 63months). Sixteen RBTs provided direct services to the participants in this study. The technicians were certified for an average of 20months (range, 1 50months) prior to starting direct services via telehealth. Technicians had experience receiving supervision via synchronous telehealth, but had no prior history with direct service delivery via telehealth.

All clinicians received telehealthspecific training on how to (a) use the technology platforms for videoconferencing and client's electronic health records for data collection, (b) ensure client privacy and adhere to Health Insurance Portability and Accountability Act regulations when providing services via telehealth, (c) build rapport with families and technicians via telehealth, and (d) effectively provide coaching and feedback to the RBT working inperson via synchronous videoconferencing. The RBTs had received prior training on how to join the videoconference for weekly clinical direction and electronic data collection when rendering inperson direct services.

Participant Identification

Archival data were obtained from a sample of 17 children and adults with ASD (ages 3 to 29years old; average age = 11years) who were receiving techniciandelivered inperson services and telehealth supervision (i.e., a partial telehealth model) prior to COVID19 pandemic and transitioned to a full telehealth service model. Participants were included in the analysis if they transitioned from inperson treatment delivered by an RBT with telehealth supervision to any model of full telehealth treatment (see data extraction procedures section below). Clinicians collaborated with the family and used their clinical judgement based on their knowledge of the client and prior performance on goals to select the specific telehealth service delivery model. Thus, many individuals served by the organization did not transition to a direct telehealth treatment model (i.e., they continued the preCOVID19 model, paused services) and were not included in the analysis.

All participants were receiving inperson treatment delivered by an RBT with realtime clinical direction via synchronous videoconferencing modalities prior to COVID19. Data from this type of service were needed to conduct the comparison analysis. Participants were not included in this analysis if they were new to services during COVID19 or immediately prior to COVID19 and had no inperson comparison data available. Initially, 24 participants were identified for the archival analysis. Seven participants were excluded from the analysis because inperson session data were not available for comparison. The inperson data were unavailable because (a) the participant was new to treatment (n = 3), (b) the participant received new and modified goals for telehealth services (n = 1), (c) the clinician initiated a previously planned fading of treatment intensity (n = 1), (d) the participant had less than three sessions of telehealth data due to use of a combined treatment model (i.e., direct inperson services combined with direct telehealth) (n = 1), and (e) the parent reinitiated inperson services (n = 1).

Data Extraction Procedures

Each participant's electronic record was reviewed by the supervising BCBA. Electronic records were stored in a Health Insurance Portability and Accountability Actcompliant, cloudbased practice management software system (i.e., CentralReach) that included all data, graphs, and progress notes. Records included the client's treatment history, initial assessment, treatment goals, individual targets, daily session data for skills in acquisition and behavior reduction goals, and updated progress reports. Ethnicity, diagnosis, and severity level of ASD, family household, and healthcare plan information were obtained through a review of each participant's records.

Child, Family, and Provider Demographics

Participants included in the analysis were 17 clients aged 317years (35% female, 65% male). Table 2 displays participant demographics. All participants had an evaluation or confirmation of ASD diagnosis within the last 52months (range, 9 52months). The primary language spoken in the home was English (n = 14), and the majority of participants were Hispanic (n = 10). Regarding group composition, 47% were from a twoparent household, 47% from a oneparent household, and 59% had at least one sibling. The majority of participants were receiving treatment through the state Medicaid plan (n = 15) with 71% living an average of 96miles (range, 46 175) from the nearest metropolitan city (n = 12). The majority of these families (75%) were required to travel across state lines to access specialty care in the nearest metropolitan city.