Delivery of ABA to Children in Rural Communities Via Teleconsultation and Rethink Autism

Background: Applied Behavior Analysis (ABA) is an effective intervention for individuals with ASD, and parents can be trained to provide ABA intervention in their home. Families in rural areas face a lack of nearby ABA service providers, thus parent training for this population is imperative. Developments in telehealth and teleconsultation may further increase ABA training opportunities for these rural communities. Rethink Autism is an online, video-based treatment program designed to provide parents with the training to implement ABA with their children at home. Although online parent training programs confer multiple benefits, therapist-assisted modalities show greater outcomes than self-directed use. Contact with a trained interventionist could bridge some of the common barriers in online parent training.

Objectives: The purpose of the present study was to evaluate outcomes of an online, ABA-based intervention with video modeling delivered to children with ASD in rural areas and supplemented by teleconsultation. This model may provide the education, training, and scaffolding needed for parents to implement behavioral interventions with their children. Outcome measures of import included the following: child behavioral gains; parent ABA skill development; fidelity of the ABA programming and implementation integrity; and generalization of ABA skills to novel behaviors. Additionally, this study reviewed access to evidence-based intervention in rural communities, cost-effective delivery of intervention, and the utility and social validity of behavioral teleconsultation.

Methods: A non-concurrent multiple baseline design was used across three rural families. Following an in-vivo orientation, three phases were completed remotely through Rethink and teleconsultation. The baseline phase involved novice participants implementing ABA using only a one-page lesson printout. This was followed by successful completion of four Rethink ABA training modules. During the intervention phase, participants had access to Rethink’s high definition video modeling and coaching delivered via teleconsultation. The generalization phase replicated baseline conditions with a never-before-seen lesson; participants had only the lesson printout without coaching or video modeling.

Results: Outcomes reveal large effect sizes for parent increases in ABA implementation integrity from baseline to generalization (Tau-U = 0.82), coupled with child skill gains in their ABA lesson programming (Tau-U = 0.80). Both Rethink and teleconsultation were rated with high acceptability and perceived effectiveness. Cost analyses show financial benefits of Rethink and teleconsultation in terms of ABA programming (annual savings = $18,051 per child), logistical expense (average travel of 49 driving hours over 2,900 miles), and ABA consultation costs (average savings by teleconsultation = $300.16).

Conclusions: This study supports the use of digitally delivered intervention to increase child skills via targeted ABA lesson programming. These gains were achieved with relatively short duration (three months) and with low intensity (four hours/week). Parents were able to develop ABA implementation skills over the course of the study through the completion of online training modules and coaching received over teleconsultation sessions. These skills were critically demonstrated in the generalization phase to a novel behavior. This model of service delivery is apropos for families living in rural geographies, elegantly addressing limitations in service access and economic burdens.