Association for Behavior Analysis International

Due to the COVID-19 pandemic, many behavior analysts who serve individuals with developmental disabilities had to transform their practice swiftly using telehealth in order to continue supporting their clients. In this international symposium, we invited practitioners from across the world who adapted their services to telehealth to share their experiences. Smita Awasthi will present a study that reports how Behavior Momentum India shifted their in-clinic services across their 10 clinics in India to in-home telehealth during the pandemic using smartphones. Guido D’Angelo will present a study conducted in Italy through their agency, Dalla Luna, in which telehealth supervision was provided to two therapists in conducting functional analysis and functional communication training. Kristín Guðmundsdóttir, from University of Akureyri, will present a study in which the authors developed and implemented a telehealth parent training protocol with 5 families in rural Iceland before the pandemic despite challenges such as low-speed internet access. Iris Heidsha Pons from Starbright Academy in Puerto Rico will share her experiences shifting to telehealth during the pandemic for a school and clinic that serves over 200 individuals. Presenters will share cultural variables they considered, barriers they faced, and will present recommendations for other professionals implementing behavior analysis through telehealth.

Board certified behavior analysts; licensed psychologists; graduate students.

Telehealth services have been applied in the treatment of a variety of problems across geographies (Tsami et al., 2019). The COVID-19 pandemic provided such an opportunity to scale up the impact of behavior analysis for children with autism when in-clinic services stopped abruptly worldwide. This qualitative and quantitative case study details how Behavior Momentum India (BMI), an organisation with 10 clinics across India transitioned services from in clinic to telehealth using the ubiquitous smartphone. A cohort of 92 students diagnosed with autism participated in this study under a team of 51 therapists, 9 behavior supervisors, and a doctoral-level Board Certified Behavior Analyst. Smartphones were used by 78% students and 82% therapists for direct 1:1 and parent-mediated sessions with 82 students. With 10 students, behavior supervisors provided parent training to continue interventions during lockdown. The critical transition decisions, logistics, and ethical challenges were identified using qualitative methods. All students continued to acquire targeted skills, while 52% of the students acquired more skills in telehealth compared to in clinic as per curriculum modification. A social validity survey provided high ratings on our organization’s initiative, and 72% parents reported that their familiarity and confidence with the science of applied behavior analysis had increased.

This paper presents the development and experimental evaluation of telehealth methods in behavioral caregiver training in rural Iceland pre COVID-19 pandemic. Lessons learned from the study will be described and considerations for professional training and practice in behavioral telehealth for families of children with autism will be discussed. The study was conducted with Icelandic families of preschool-aged children with autism that did not have access to evidence-based services. The experimental design was a multiple baseline across parent and child skills, replicated across 5 families. Both quantitative and qualitative data were collected for experimental and social validity purposes. Caregivers were taught to apply the TeachingDANCE (Ala‘i-Rosales, Cermak og Guðmundsdóttir, 2013) during play interaction with their children in order to teach their children social communication skills and enhance the quality of the relationship between the parent and child. The majority of the training was conducted through telecommunication methods. The results showed measurable progress for parents and children across all skill areas. Furthermore, the caregivers valued the increased access to evidence-based intervention and expertise, despite various challenges during the intervention. The results indicated that training via telecommunication is a viable approach for rural families with low-speed internet connection. Critical training components for higher and continuing education will be highlighted and recommendations for professional training and practice will be discussed in the context of the research as well as the lessons learned. These recommendations include considerations regarding technical skills, effective training procedures, ethical and cultural considerations, and challenges when conducting data-based behavioral consultation via telecommunication.

Kristín Guðmundsdóttir is an Assistant Professor in Psychology at the University of Akureyri, Iceland. Kristín holds a Doctoral degree in psychology from the University of Iceland and a Master of Science degree in behavior analysis from the University of North Texas. She is also a Board Certified Behavior Analyst (BCBA) since 2003. Kristín has served as the President of Icelandic ABA and has been an active participant in the shaping of behavior analysis in Iceland. Kristín has worked as a therapist and case manager in early behavior intervention for young children with autism and other developmental disabilities in Iceland and the US. She also has extensive experience teaching and consulting with children and caregivers in the Icelandic school system, specifically in rural parts of Iceland. Kristín’s current research focus includes behavior intervention for families of young children with autism and other developmental disabilities via telehealth. Specific emphasis is on caregiver training for rural families that have limited access to evidence-based services.

The COVID-19 pandemic has had an impact on the education, family, and social aspects of people with autism spectrum disorders (ASD) in Puerto Rico. Starbright Academy serves 116 individuals from the ages of 2-21 years in our school program and 101 individuals with ASD and other related disorders in our clinical program (MO Therapy). The pandemic challenged us to transfer our educational and clinical system from face-to-face to a virtual one. Within 5 weeks of the initial “shut down” in 2020, Starbright had converted all of our in-person services to telehealth. We conducted academic and clinical programs through telemedicine for 76 children for 10 months. In this discussion I will share the lessons learned during this transition. Specifically, I will discuss how telemedicine has had a positive impact in educating all family members in ABA techniques, the significant improvements we have seen in the well-being of the family threw the application of telehealth in these homes, the development of independence skills and the generalization of other skills learned at school into the home setting. I will also share the obstacles that we faced in Puerto Rico for receiving ABA services, other challenges encountered during this transition to telehealth and provide recommendations for future providers.