1.       The compounded stress on caregiver (parent/guardian)

2.       The challenge in scheduling of sessions

3.       The adequacy of dosage or the frequency of sessions

4.       The choice of telehealth programs delivery

The result of the study indicates that services such as ABA therapy over the web (telehealth) is usable, feasible, and acceptable by caregivers.  Overall, the compounded stress on caregivers seems to decrease due to increased sense of efficacy and therefore more satisfaction. One of the key challenges include scheduling of therapy sessions. The caregivers are indifferent regarding the choice of telehealth delivery and dosage. Their choice rather is on the focused programs which could be both direct coaching and module-based learning. 

The study suggests that there is an increased sense of competency among the caregivers. This means the interventions learned through telehealth are working and helping their family members with ASD. Probably this is the same reason, the caregivers feel an increased sense of efficacy and satisfaction in caregiving. 

https://www.youtube.com/watch?v=hlMyr7nR02o 

There are many ways to help develop a child’s joint attention. The above link demonstrates one way to help develop joint attention in individuals with ASD. In the video, a blue flashlight is used. When flashed upon a target, visual stimulation is evoked. This calls for an engagement into the activity in expectation for joint attention.

When two individuals focus on the same thing, it could be called a joint attention. Joint attention is one of the key skills to achieve the developmental milestones of a child such as bases of language, communication, and social interaction. Often individuals with autism lack joint attention skills and hence face difficulty in language development, delay in communication and challenges in social interactions with others. In fact, lack of joint attention is also considered one of the diagnostic criteria for ASD. 

Similarly, joint attention is the basic learning skill to acquire any new skills in life. When one can communicate, use language, and socialize, the problem behaviors could be decreased. Acquiring life skills through learning can be beneficial to self-regulate and navigate about regular settings where social cues are typically followed.

https://www.youtube.com/watch?v=-fYuMzA9Js8

The above link is a video that demonstrates a step-by-step process on how to brush teeth. The video is attempting to model other children to follow the child in the video. 

Modeling could be showing anything to teach them how to perform an activity. The activities of daily living (ADL) are an important part of getting by on a daily basis with one’s life. Similarly, hygiene on a regular basis such as washing your hands and brushing teeth are very important. Caregivers (parents) are usually the first person to model. This is a direct modeling. Other direct modeling can be performed by peers, teachers, therapists, and practitioners. 

Video modeling is also becoming popular because many of the times caregivers (parents) run out of ideas and search on the web. Modeling on the web comes in the form of videos. Since individuals with ASD usually like screen time, it creates opportunities for modeling. Moreover, videos can be repeated as many times as it takes unlike a real person. 

 

This first resource is a mock ABA Parent Training via telehealth (without the client present).  This resource helps show and give ideas about what a telehealth parent training should look like for behavior intervention planning and follow through.  This would in my work with individuals with ASD by not only giving me ideas on how to conduct a parent training via telehealth but also it helps support the positivity and feasibility of telehealth sessions with and without clients present.  It supports that parents can learn behavior interventions to implement with their children over telehealth in times of COVID but also if that works best for their schedule. 

 

 

This resource is a video of a BCBA talking about what telehealth is, how it benefits clients, parents and clinicians as well as the ethics it keeps and can promote even though it is conducted online.  This video is also helpful as it produces additional back-up resources and articles to support the demand and feasibility of telehealth. The most interesting part of the video in my opinion was learning about the ethics behind conducting a telehealth sessions as I feel this might be overlooked in that we use computers and tablets in our every-day lives with rarely having to get consent.  This resource helps promote client dignity for our clients with ASD receiving services which aids in our work in all aspects of programming, running trials, collecting behavior data, as well as conducting telehealth sessions. 

 

Study 1 evaluate the behavior intervention via telehealth based on three feasibility aspect which are usability and feasibility of the program, effect of the program on caregiver stress, and choice of telehealth dosage. The results of this study are analysed from survey , The Parenting Sense of Competence completed by the caregiver, coach. The results suggest that behavior intervention via telehealth is usable and feasible for caregivers, increase sense of efficacy and caregiving satisfaction while decreasing the caregiver’s stress.

 

Study 2 investigate how caregivers would choose when given three different program consists of online modules, videoconferencing with BCBA-Ds and different hours of training. Based on the choices selected by the caregiver, it can conclude that direct coaching via telehealth may be an indispensable part of behavioral intervention via telehealth which more resources or teaching are required in training interventionist via telehealth. 

 

 

This research investigate whether it is feasible and effective to train parents to implement ABA via telehealth.The result suggests that caregiver can successfully implement functional analysis and functional communication training via remote video coaching and there are no significantly difference between in person or via telehealth. I see another possibility in my work which is to implement intervention or teaching via telehealth since the result in this research showed the effectiveness and accountability of telehealth in delivering ABA service. Also, using telehealth is a lower cost intervention that may be suitable for some families who consider the financial aspect. 

2.  

This is a video of ABA telehealth parent training recorded during real training session. In this video, there are two scenarios with  the same family and the BCBA. The BCBA are teaching the parent to teach her kid to follow commands. The function of the problem behavior in the first and second part of the video are escape from demand and attention seeking respectively. From this video, I have an idea on the steps to do ABA telehealth parent training such as giving clear instruction of what the parent could do at that moment. For example, when the little boy left his seat when given the coloring task. The BCBA would ask mum to physically hold the boy and guide him back to the seat, restate the command and tell the boy he could have his reinforcer after coloring. Also, the BCBA keeps giving praise and feedback to the child’s mum to reinforcer her for engaging in this parents training. 

This webinar video conducted by a BCBA provides some tips and tricks for ABA tele-health sessions, and what to expect. Specifically this focuses on how to prepare for them, and why it is so important for parents to be trained in ABA.

Though I am not currently working with any individuals with ASD, I am better equipped with why these sessions are vital for caregivers to gain competency in practicing ABA therapy with their individual with ASD. This video only further demonstrates how practical telehealth sessions are.

This video discusses parent training in applied behavior analysis. The benefit of using distance education models (tele-health) are mentioned. Online training has proven to be very effective. Power points, parent training curriculums, video models, and video conferencing can all be used. It explains how to use an online training platform, and also provides a checklist for creating a platform.

This was a clear outline on parent training. I can better explain why parent involvement is so important, and provide information on distance education as a source of how to lead parent training. 

to caregivers of children with ASD.” 

The purpose of the study was to assess the effectiveness of telehealth as a modality for delivering services. The goal of services is for a learner to become self-sufficient and capable in all areas of life. The paraprofessional delivers evidence based practices with the goal of the learner being able to achieve success without a paraprofessional present. The same goes for providing EBP and training to the caregivers of learners with ASD. The study discussed how it is hard to determine "what portion of knowledge gain came from the precession video modules and which came from the more time- and personnel-intensive sessions with BCBAs." 

The goal of the study is for caregivers to have access to training on EBP that increases their caregiving ability. The studies in this article showed that delivering training via telehealth was effective however it was hard to work around schedules to deliver training to the caregiver. 

 

Neely, Leslie C., et al. “Iterative Development of Caregiver-Implemented Behavioral Intervention via Telehealth: A Focus on Feasibility.” Perspectives of the ASHA Special Interest Groups, vol. 7, no. 2, 2022, pp. 295–309., https://doi.org/10.1044/2022_persp-21-00219. 

 

Another EBP that can be used to teach communication skills is Functional Communication Training. FCT provides the child with a functional form of communication to get their needs met. If a child is used to screaming to get their needs met, the child can be taught to say “No I want ____” instead of screaming. This changes their life by giving them a means of communication that does not cause stress of caregiver and is a much more appropriate response. AAC’s are also another means of communication for nonverbal learners. This is a HUGE impact on the lives of learners because it gives them the ability to communicate functionally. 

An EBP for skill acquisition would be direct instruction (DI) and DTT (discrete trial training.) Discrete trial training is a great tool to help learners acquire new skills. 

An EBP for development of transition and employment plans would be video modeling and video supports. As learners reach high school age and transition to college and beyond they need explicit visual instruction to help them do their everyday tasks. 

This video discusses the functions of behavior including access and escape. Learners often want to gain access to something or to escape something. Knowing the function of a behavior would aid in my work with children with ASD in that I would be able to respond appropriately. A learner I worked with may have a behavior that starts out as a way of gaining access or attention and then over time is used to avoid or escape. For example, a nonverbal student may scream because they want access to something and then over time they notice that whenever they scream they are able to escape tasks they don’t want to do. So in this case it is important to identify what the function or the multiple functions of behavior are. To identify the antecedent, behavior and consequences of the behavior in different situations. As a result of identifying the function behavior, I can teach my learner an alternative way to either gain access or an alternative behavior to escape.

Functional Communication Training 

This video was created by Virginia Commonwealth University’s Autism Center for Excellence. In this video, Functional Communication Training is defined. FCT is a way to get your needs met and to advocate for yourself. The video also discusses how learners with ASD may use verbal speech to communicate and some may not. It’s important to know the different types of communication modes. In my career as a paraeducator I have used PECS (picture exchange communication system) and I am also learning how to use sign language. Communication is a critical foundational skill especially for the preschool age learners that I work with. A key detail of this video that I plan to use in my work is the use of a system based on the student’s strengths. It does not make sense to use PECS with a learner who does not understand visual picture symbols. They may understand sign language which is a more universal language. It’s important to let the learner lead in choosing a communication method. It’s also important to partner with other professionals including the SLP in implementing a communication method that is right for the learner.