The COVID-19 pandemic completely changed how patients and clients access their medical and related services. While the idea of telehealth is not new, it became a necessity in 2020 to help keep staff, patients, and clients safe. As of 2022, many in-person services have resumed, however, telehealth services (including ABA therapy) are still a viable option for many clients and families.
The idea of telehealth dates as far back as 1879 when medical doctors were advertising their services via telephone in the local paper. Telehealth in 2022, of course, looks quite different, and clients can connect directly with their ABA clinicians via applications such as Zoom, Skype, and more. However, while telehealth services are widely available, how effective are they when it comes to ABA treatment? Read on to learn more about what ABA telehealth looks like, the different types of models, and the advantages and disadvantages of ABA telehealth treatment.
What Is Telehealth ABA Therapy?
In-person applied behavior analysis (ABA) therapy, whether it’s delivered in clinic or in the home or community, helps children with autism spectrum disorder (ASD) overcome developmental challenges, improve their social skills, improve daily life and living skills, and strengthen cognitive skills. The in-person approach to in-person ABA is an important component, especially when ABA clinicians are trying to manage a client’s challenging behaviors. However, the COVID-19 pandemic showed that ABA delivered via telehealth can be effective, and it can help develop most of the skills that can be delivered in person.
Telehealth ABA sessions may look different than traditional ABA sessions, however, it can be just as effective, particularly if parents are strongly involved and prepare well for individual sessions. Telehealth varies for every client, depending upon their individual needs. Most times, the ABA clinician will meet with the client virtually using an app or program. These can include FaceTime, Zoom, Microsoft Teams, and other HIPAA-compliant methods. Clinicians and clients can also talk by phone in lieu of a video session; however, video sessions are most effective. The child can use a variety of devices to connect with Telehealth, such as a desktop or laptop computer, tablet, or smartphone. The therapist can be in person with the supervising clinician joining virtually, or both can be virtual. Telehealth is appropriate for many individuals in a variety of circumstances, but not for everyone. Your supervising clinician would be able to discuss options with you.
How Can Parents Assist in ABA Telehealth Sessions?
Before beginning ABA Telehealth sessions, talk to your board-certified behavior analyst (BCBA) who is managing your child’s case. It’s essential to discuss expectations before Telehealth services begin. Just as with in-person ABA sessions, parents should be actively engaged. While Telehealth services may be different, the level of parent engagement should remain the same, if not increase.
Your BCBA will likely advise you to look for an area in your home that’s free from clutter, such as toys, and is away from the “commotion” of the house. If your child has a preferred toy or is fond of screen time, make sure these items are put away and out of sight before Telehealth begins, as they can be a distraction. The area should also be comfortable—if your child is sitting upright in a chair trying to stay engaged on a computer, they may become restless and uncomfortable after a while. While you don’t want to distract your child with preferred items, you do want them to be as comfortable as possible to maximize their engagement.
Parents should also be able to communicate with the BCBA and treatment team effectively, to offer updates about their child, and ask questions when needed. The BCBA and parent(s) should discuss which is the best form of communication (text, email, phone) that’s comfortable for both to have open communication. The treatment team may also provide a list of tasks to help keep your child engaged in treatment. It’s important to follow the BCBA’s suggestions if possible so that Telehealth can be most effective for your child. The basics likely include:
- Having a device or computer with the ability to connect via video and microphone, preferably with a headset for privacy reasons.
- A reliable internet connection.
- A private area and a time of day that’s free of distractions or interruptions.
As treatment progresses, your treatment team will have more ideas on how you as a parent can be engaged as well as activities and models you can perform with your child.
What Are the Different ABA Telehealth Models?
ABA delivered via Telehealth has several different modalities, and you and your ABA clinicians can decide what is the best fit for your child and your family. Modalities of ABA Telehealth can include synchronous or asynchronous sessions. So what exactly does that mean?
Simply put, synchronous modalities of ABA mean that your child receives live treatment and interacts with their clinician or therapist, whether it be using video, audio, or chat. Asynchronous modalities describe a program where the child receives instruction and therapy (such as a video, worksheet, etc.) that is to be watched or worked on later, then responded to. Asynchronous ABA Telehealth treatment requires a higher level of parent engagement, as these are tasks that a parent would have to help guide most children through. However, asynchronous treatment is a better fit for some families, particularly those with busy schedules or time constraints.
Telehealth ABA Supervision
Supervision can also be delivered via Telehealth, even if there are in-home sessions with a therapist. This will be conducted virtually while your child is having their scheduled session with their therapist.
There are several ABA clinicians that likely will be working with your child. The board-certified behavior analyst (BCBA) holds the supervising position. He or she will have a master’s or Ph.D. degree in psychology or behavior analysis, must pass the board certification exam, and may also be licensed in their state of practice. Your child will also work with a registered behavior technician (RBT) or behavior technician (BT). A registered behavior technician has had behavior-related certification, while a behavior technician has received the same training and is well-versed in ABA and therapies.
The person you’ll see most often during ABA Telehealth therapy sessions is the RBT or BT. If it were an in-home session, the same would be true. The BCBA takes a supervisory role when it comes to sessions, and typically attends sessions several times a month to supervise the RBT or BT. Different states have different regulations when it comes to how many hours a BCBA is to directly supervise.
For those using Telehealth ABA, supervision will be delivered via video (or audio/chat) as well, and can also be either synchronous or asynchronous. In a synchronous modality, the BCBA will join in on the Telehealth session with the other staff. Not only will the BCBA observe, but they will also provide ideas for intervention and update the treatment plan as needed. Real-time feedback is also provided using a synchronous modality.
BCBAs can also supervise using an asynchronous modality. To do this, sessions are recorded, and the BCBA plays them back at a later date. They then provide feedback, suggest interventions, and share communication via the chosen method, such as real-time video, chat, email, text, and more.
A client can have Telehealth supervision from their BCBA even if they have consistent in-home sessions with their RBT or BT. This can be due to the BCBA’s schedule or distance, or clients can sometimes have extra supervision hours delivered via Telehealth, meaning they get the benefit of both in-person and Telehealth services. During an in-home session, a BCBA will join the session via a device in the home, such as a laptop or tablet, and will supervise the session remotely. They will likely provide real-time feedback and communication after the session to both the RBT/BT and the parents.
How Effective Is ABA Telehealth Therapy?
While the idea of Telehealth for many types of services has been around for over a century, the implementation of Telehealth really occurred during the height of the COVID-19 pandemic in 2020. Because it’s so new, there isn’t much research out there yet, however, the research that is available is favorable. One study published in December 2020 relayed that children transitioned well from in-person ABA services to the sudden switch to virtual. Having ABA Telehealth therapy was consistent and an improvement was seen in the child’s behavior. Of course, more research is needed as Telehealth ABA therapy becomes more established, however, initial results designate virtual ABA therapy to be effective, particularly in certain situations.
What Are the Advantages and Disadvantages of ABA Telehealth Therapy?
While ABA Telehealth therapy is indeed effective, just as with any type of therapy, there are upsides and downsides, and Telehealth may not be a good fit for every child. Also, some families may simply prefer in-home services over virtual ones. Every child with autism is different, and therefore, their needs and treatment plans vary widely.
Some of the advantages of ABA Telehealth therapy include:
- Convenient to schedule. Some families have very busy schedules with other services, siblings, etc., and scheduling consistent in-home visits can be difficult. Using Telehealth ABA services allows families with tight schedules to fit ABA in.
- Teaches virtual skills. Using a device, such as a computer or tablet, for ABA sessions allows your child to enhance their technology and virtual skills, which are undoubtedly important in today’s world.
- Manages health concerns. If you’re anxious about an ABA clinician coming into your home for health reasons or you or your child are sick, in-person sessions may not be an option, if only temporarily. Telehealth allows you to address those health concerns and keep ABA schedules consistent. If you have in-home services and your family is ill, you can maintain consistency by supplementing with Telehealth ABA.
- Provides more communication. You may want to supplement your in-home or in-clinic visits with supervisory Telehealth or extra ABA sessions if your insurance allows it. Telehealth allows for more supervision time for your BCBA and gives you more access to open communication.
- Keeps a routine. Whether your ABA schedule includes only Telehealth sessions or you’re supplementing in-home with virtual, Telehealth sessions help maintain routines. They’re very convenient for families with busy schedules, and they can help keep routines during holiday breaks, vacations, and times of illness.
- Provides access to therapy. There is a definitive shortage of BCBAs and RBTs across the country, and many children in rural areas have no or limited access to ABA therapy. Having Telehealth services allows the child to still receive therapy—keep in mind, your Telehealth treatment team does not even have to reside in your state as long as insurance allows it, giving you access to more providers.
- Less expensive. Whether you’re paying out of pocket for ABA therapy or have a copay with your insurance company, Telehealth sessions are less costly than in-home or in-clinic sessions.
- More comfortable for some children. Some children, particularly those with anxiety issues, may feel more comfortable with Telehealth at the outset, with the hope of moving to in-home services to treat social skills deficits.
There are some disadvantages of Telehealth ABA therapy, and it may not be a great fit for all families. Some disadvantages may include:
- Its effectiveness across clients is varied. While recent studies point in the direction that Telehealth ABA is effective, more research is needed as to the characteristics of the client and family which increase the likelihood of success. Many parents may be wary of investing time and money into a modality they’re not sure will work. However, it’s important to keep in mind that Telehealth doesn’t have to be the only therapy modality—you can always supplement in-home or in-clinic sessions with Telehealth.
- You may not feel fully supported. Some parents (and children) just don’t adapt well to the virtual way of doing things and need that in-person support. For these families and children, Telehealth can be supplemented but shouldn’t be the only option.
- Your child is not engaged. It can be difficult for children with autism to adapt to change. If Telehealth is introduced after in-home ABA therapy, your child may be resistant to the change. It may take some time to adapt while you find a comfortable area in the home and time of day for Telehealth. Virtual services can be especially difficult for children with ASD when it is also comorbid with attention-deficit hyperactivity disorder (ADHD).
There are many reasons families choose Telehealth as the only form of ABA therapy and many reasons families choose to supplement with Telehealth services. Ultimately, it is up to you to determine if virtual services may be beneficial for your child, particularly if you’re comfortable with your current schedule. However, keep in mind Telehealth ABA therapy is a great option during holiday breaks, summer, vacations, and other times when in-home sessions aren’t an option.
Dennison A., et al. (2019). Delivering Home-Supported Applied Behavior Analysis Therapies to Culturally and Linguistically Diverse Families. Behavior Analysis in Practice. 12(4):887-898. 10.1007/s40617-019-00374-1
Lenley, S.M. (2021). Telehealth, supervision, and technology in ABA. Retrieved on November 16, 2022, from: https://guidingtechnologies.com/wp-content/uploads/2021/07/Telehealth-and-Supervision_slides.pdf
Lindgren S., et al.(2016). Telehealth and Autism: Treating Challenging Behavior at Lower Cost. Pediatrics.37 Suppl 2(Suppl 2):S167-S175. 10.1542/peds.2015-2851O
Pollard, J.S., et al. (2020). The effects of transition to technician‐delivered telehealth ABA treatment during the COVID‐19 crisis: A preliminary analysis. Journal of Applied Behavior Analysis, 54(1): 87–102. 10.1002/jaba.803