28673
Teleplay: A NOVEL Approach to Combat the EARLY Identification Disparity in a RURAL Community
Recent research suggests that Telehealth can be useful to accurately identify ASD (Reese et al., 2012; Smith et al., 2017), thereby demonstrating its potential for improving early identification in rural and underserved areas where accessibility to ASD diagnostic and intervention services are limited (Mandell et al., 2005, Stahmer, 2007). Although technology accessibility, limited insurance coverage, funding, and lack of in-person connections present barriers to Telehealth (Antezana et al., 2017, Machalicek et al., 2016), better utilization of technology for information sharing could provide physicians working in rural areas comparable access and online support to expedite the screening, intervention, and referral process.
Objectives:
To pilot Teleplay, an interactive Telehealth platform, in a rural physician’s office in order to assess implementation feasibility, the impact on early ASD identification, and the impact on rural medical staff ASD knowledge relative to signs and management. The ultimate objective is to improve early identification in rural communities by integrating ASD specialists into the medical home via Teleplay and by increasing rural physicians’ knowledge of ASD signs using their own patient’s annotated video samples.
Methods:
Teleplay was developed with National Libraries of Medicine project development funds as an interactive tool to connect rural medical teams with university based ASD experts for communication about children who are at risk for ASD. Teleplay is implemented as follows. 1. When children fail the M-CHAT at 18- or 24-month well child visits, caregivers are invited to complete the Structured Play Assessment (SPA; Ungerer & Sigman, 1981) in the physician’s office with their child; 2. The SPA is video recorded by a nurse and securely uploaded via Teleplay to a university-based ASD Clinic; 3. The ASD team observes the video, scores the CARS-2 (Schopler et al., 2010), which is embedded into the Teleplay interface, and time stamps and annotates red flags; 4. The ASD team then sends the annotated time clips with the overall description of any ASD symptoms, and general referral recommendations (i.e. early intervention, speech, full autism evaluation) back to the physician via Teleplay; and 5. The physician uses the videos to communicate feedback to caregivers. Using a logic model (Rubio et al., 2010), the feasibility of implementing Teleplay will be assessed. Finally, the physicians and staff will complete pre-and post ASD quizzes to assess the impact of Teleplay on knowledge of ASD symptoms and management.
Results:
The Teleplay pilot study is active and will conclude in early spring. ASD knowledge was assessed prior to Teleplay implementation. Physicians, residents, and nurses completed a 10-question quiz adapted from the CDC Autism Case Training for developmental-behavioral pediatrics and averaged 73.7% accuracy. The quiz will be re-administered post Teleplay implementation. According to initial assessment using the logic model, collecting and uploading the SPA, scoring and time stamping children’s videos, and returning videos to physicians is feasible. Challenges and perceptions will also be assessed and discussed.
Conclusions:
Teleplay is a novel platform that offers a promising solution to the accessibility disparity experienced by children with ASD and their families living in underserved communities.