Telehealth Delivery of Cognitive-Behavioral Intervention for Anxiety in Youth with ASD: Perspectives of Parents in Rural Communities

Background:  A comparative effectiveness review by AHRQ (2014) determined that there is now a “strong body of evidence” supporting cognitive-behavioral interventions targeting anxiety and mood symptoms in youth with ASD who are verbally fluent.  For families living in rural communities, access to specialists who have been trained to deliver evidence-based treatments, such as CBT, is severely limited.  Telehealth delivery of evidence-based interventions has the potential to improve access to services for rural families.   However, little is known about how to modify evidence-based protocols for delivery of psychosocial interventions through telehealth in a manner that is acceptable and feasible for families.

Objectives:  To examine parent perceptions of credibility, feasibility and impact of  a short-term telehealth intervention designed to reduce interference and severity of anxiety symptoms in youth with ASD.  Results will inform revisions of the model in planning for a large, multi-site trial.

 Methods:   Twenty-six parents participated in a pilot study of telehealth delivery of Facing Your Fears (FYF; Reaven et al., 2011), which is an empirically supported, manualized, multi-family group CBT for anxiety for youth with ASD.  Parents completed several questionnaires focused on acceptability and feasibility of delivering mental health interventions directly to youth with ASD through videoconferencing before and after engaging in the intervention.  Parents also completed a structured exit interview that probed for feedback regarding intervention content, delivery and impact. Efficacy data (published elsewhere) will be reviewed briefly and long-term follow-up measures of anxiety symptoms are being collected to assess sustainability of effects.

Results:  Credibility and acceptability ratings by parents were consistently high before, during and after the intervention.  Qualitative data from the exit interviews are being analyzed through Atlas, a software program that identifies emerging themes and associations amongst themes.  Thus far, the majority of parents perceive telehealth as a viable option for improving access to specialty mental health care.  Many cite the ease of engaging their son or daughter in a treatment session that occurs via the home computer as a benefit and several reported knowing of no local alternative to the services provided through this telehealth program.  Few parents expressed any concerns about risks to confidentiality.  The majority of families identified the need for ongoing support from project therapists, suggesting the importance of long-term sustainability.

Conclusions:

Parents who participated in a short-term, multi-family CBT intervention with their son/daughter with ASD via telehealth report that the approach is credible, acceptable and feasible.  Analysis of their feedback regarding ways to improve the program are ongoing.  Many parents have expressed interest in building sustainable models wherein clinicians can be accessed as needed by project participants.  Limitations and future directions will be discussed.

This study was funded by Human Resources and Services Administration (HRSA; R40MC15593-01-00).