ABA Education Foundation
5694 Mission Center Road, Suite 602, PMB 341, San Diego, California 92108
Phone 619.272.0090 Fax 619.220.0215
March 25, 2020
ABAEF Early Start Intervention: Telehealth Services
ABA Education Foundation (ABAEF) has developed a telehealth protocol to provide ABA services to individuals currently being treated in their homes or schools, as a response to the current global health emergency of COVID-19. By utilizing electronic methods, programs can be maintained, developed, modified, and monitored remotely for both skill acquisition as well as behavior reduction goals. ABAEF currently utilizes electronic programming and data collection for ABA intervention that are capable of targeting programming according to Individualized Family Service Plans (IFSP), as well as to meet the current needs of each family given the unique circumstances of this global health emergency.
By providing telehealth services, scheduling sessions can be flexible to times and days that are both convenient for families as well as times of days that are most ideal for targeting various skills (e.g., targeting use of utensils at mealtimes). These remote sessions can be provided on a routine schedule or last minute when families have an emergency need, such as real time consultation for video recorded behavior challenges.
Telehealth services from ABAEF also include support with creating schedules or structured routines, communication systems, data collection systems, visual supports, and any other necessary materials the family might need. ABAEF has developed systems for of delivering these materials to client homes so as to reduce any burden on families as they navigate these unique circumstances. In order to provide continuity for families and minimize regression in both skill acquisition as well as with challenging behavior, ABAEF proposes the following guidelines for remote ABA sessions.
- Mode of Communication: Telehealth Early Start Intervention will be conducted via remote electronic communications such as Zoom. Capable electronics include a smart phone, tablet, or computer. Each ABAEF team member will continue to utilize their individually assigned tablets. However, ABAEF will be flexible with the family’s use of electronic communication that is most convenient and accessible to them. ABAEF will provide an electronic device for families who do not have access.
- Staff: Telehealth Early Start Intervention teams may consist of one to two Behavior Instructors as well as a Program Supervisor. If possible, ABAEF will provide access to staff who previously provided in-home support.
- Service Description (General): Telehealth Early Start Intervention will continue to target client’s instructional program based on the principles and procedures of applied behavior analysis (ABA). Such procedures may continue to include prompting, shaping, chaining, discrete trial ABA Education Foundation teaching (DTT), pivotal response treatment (PRT), reinforcement schedules, as well as behavior reductive procedures. Emphasis will be on maintenance of skills and the continued development of the following skills: speech and language, general knowledge and comprehension, self-help, motor skills, and social/emotional development. These skill areas will be targeted based on Individual Family Service Plans (IFSP) as well as the results of previous individual assessments (e.g., Brigance, ABLLS).
- Service Description (Parent Coaching): Some parents may choose a parent coaching model for support during this time to help them navigate various family activities (e.g., meals, specific play activities, behavior management, how to create routines, etc.). The ABAEF team can also provide tutorials for social stories, visual schedules, token economies, etc.). ABAEF team members can also design programs to meet needs of families during this unique period (e.g., gross motor activities specifically for indoors or small outdoor spaces).
- Data Collection: Data will continue to be collected and analyzed via the electronic data collection and management system, Catalyst by Data Finch. Catalyst allows ABA interventionists to develop unique and individualized programming while gathering a wide variety of different types of data on a mobile device. Electronic data will be collected not only on the individual skills of each client but also on caregiver implementation of various techniques.
- Outcomes: Data analysis will be conducted remotely on a daily or weekly basis via Catalyst depending on the unique needs of each client. Supervisors will be able to monitor client performance remotely. Data analysis will include reviewing various skill acquisition programs, such as introducing new targets when needed, individualizing teaching strategies, developing new skill areas for focus as clients progress through their overall objectives, and troubleshooting any lack of progress. In addition, data collection of behavior measures will be analyzed for behavior reduction goals, including the analysis of effectiveness of behavior intervention plans.
Telehealth Session: The interventionist (Behavior Instructor or Program Supervisor) will contact the family and arrange for an agreed upon time for the remote session as well as what electronic form of the remote session.
General Session Set Up (2 Hour Session):
9-9:05AM: Interventionist will review the intervention plan for that current session while also providing the caregiver an opportunity to express any concerns or needs. Depending on these discussions, objectives will be established for focus during current telehealth session.
9:05-9:10AM: Interventionist will coach caregivers on what teaching strategies will be utilized to target session objectives including a review of instructions, criteria for a correct response, any prompt and prompt fading procedures, as well as consequence procedures. Caregivers will be prompted to gather any required materials already provided by ABAEF for the intervention session, including teaching materials, reinforcers, visual supports, and any recommended changes to the environmental setup for
9:10-9:20AM: Interventionists will demonstrate implementation of the teaching techniques, provide caregivers a chance to practice, and provide feedback to the caregiver. This includes providing an opportunity for the caregiver to ask any clarifying questions. Repeat as needed until caregiver feels ready for direct implementation with their child.
9:20-10:40AM: Caregiver will provide direct implementation of the specified programming areas with their child. During this time, caregivers will be provided feedback both in-real time during implementation as well as following their direct demonstration of teaching, depending on the specific needs of the caregiver and child.
10:40-10:50AM: Debrief with caregiver about current session and establish skill areas for caregivers to continue to focus on outside of intervention sessions.
10:50-11:00AM: Discuss possible objectives for next intervention session.
Example Goal Objectives:
Feeding/Eating (Spoon): With food already on the spoon, individual will eat food by bringing a spoon from the plate to their mouth.
Puzzles: Individual will complete a six-piece inset puzzle.
Shape Sorter: Individual will put shapes into a shape sorter.
Play Skills (One-Step Play): Individual will imitate, one-step actions using a thematic play set.
Imitation with Objects: Individual will imitate up to five actions using objects.
Gross Motor Imitation: Individual will imitate up to five gross motor movements.
Example Session Breakdown:
9-9:05AM: Goal objectives detailed above will be discussed in addition to any need’s caregivers express the day of session.
9:05-9:15AM: Interventionist will demonstrate teaching techniques and caregiver will be coached on teaching procedure for each objective (Note: this can also be repeated before direct implementation as needed).
9:15-9:25AM: Caregiver will practice giving instructions, what prompts to be used, and consequences depending on child’s response. For example, with the puzzle, caregiver will practice giving the instruction, “Do puzzle,” while presenting the puzzle with only 5 pieces out. They will detail what prompt will be used when given different possible responses by their child. The interventionist will provide feedback during this exercise before confirming with caregiver they are ready for direct implementation.
9:25-9:45AM: Direct Implementation of Feeding/Eating (Spoon) with yogurt for breakfast.
9:45-10:05AM: Direct Implementation of Puzzle and Shape Sorter, alternating between these programs to maintain attention.
10:05-10:20AM: Direct Implementation of Play Skills (One-Step Imitation) with a farm set and doll house.
10:20-10:35AM: Direct Implementation of Gross Motor Imitation and Imitation with objects using DTT as well as natural play skills in between trials.
10:35-10:40AM: Debrief with caregiver about what teaching methods they felt were effective and ineffective as well as which areas caregivers feel confident in or need more practice.
10:40-10:50AM: Discuss ways to generalize the six objectives that were targeted today but in more naturally occurring situations outside of intervention sessions (e.g., individual initiates with a car ramp, target one-step play actions).
10:50-11:00AM: Discuss possible objectives for next intervention depending on both the skills of the child as well as the implementation skills of the caregiver.
Notes: We do not expect caregivers to run a typical ABA session as the ABAEF team would do in normal circumstances. The above are only examples of goals to target and suggestions of how we can support families to accomplish these goals. We will work with each family to determine how to best support their needs.
Session lengths can vary based on the needs of the family. Breaks can be incorporated as needed, as with in person sessions.
In addition to client data taken through Catalyst, the ABAEF team will complete a Telehealth Session Log for each session.
The ABAEF team can offer suggestions for family/sibling activities and offer resources, materials, and/or lead such activities remotely.