CEHD Remote Research Roundtable: Applications of Telehealth Approaches
for Research and Training
An overview of telepracticeAdele Dimian, Ph.D. ([email protected])Institute on Community Integration May 2020
Roadmap
DESCRIBE THE DIFFERENT
TELEHEALTH MODELS
DISCUSS CONSIDERATIONS
FOR USING TELEHEALTH
DISCUSS COMMON PROBLEMS
PRESENT CEHD PROJECTS AND
RESOURCES
What is telehealth?
The World Health Organization defines telehealth as including:
• “ [telehealth] is broader in definition than telemedicine as it includes computer-assisted telecommunications to support management, surveillance, literature and access to medical knowledge”
• Telepractice, telecommunication, telemedicine
Models of telepractice
Synchronous
Online learning modules
Asynchronous
Both
Hardware considerations
• Computer• Tablets/ Smart phones• Hot spots
A device is needed to connect to the
Internet
• Internal cameras are built into some computers and most tablets and smart phones
• External web cameras connect via USB or BluetoothWeb cameras
• Tripods, popsockets• Microphones• Bluetooth headsets
Additional equipment
Software considerations
• Zoom (HIPAA compliant)• Google Meets (Chrome browser)
Video conferencing platform
• Screen Cast O Matic (UMN)Screen capture recording
• Canvas • Google suite, record in Powerpoint or Zoom Training
• Email • SlackCommunication
• Box (encrypted, secure)• Encrypted hard drive Storage
Protocol considerations
IRB approval and modifications (Tiers)
Online Consent forms• Qualtrics• DocuSign
Ensuring privacy and security• Lock your Zoom room• Use a password• Save any data to encrypted storage devices (hard
drive or Box)• VPN
Checklists• How are you going to connect and set up a
session with an end user?• What are you going to do during your session?• How are you collecting data?• Multisite coordination?
Safety considerations
High risk behaviors
Ethical guidelines and professional scope
Termination criteria
Mandated reporting
Set up considerations
A wide view of the room is helpful depending on what the end user is being asked to do
Place the camera or device up high
Connect before your session (technology and environmental check)
Interpreter services
Common problems and troubleshooting
Internet Connectivity
Bandwidth
How many people are online?
Where is your router located?
Audio and Visual issues
Drivers
What browser is the user using?Software up to
date?
When in doubt, RESTART!
Tele use across CEHD
NDBI Autism
HOME inventory
Check and Connect
Research & Training Center on Community
Living
Project BASE
ECHO Addressing the Opioid
Crisis
Resources• IRB:
https://drive.google.com/file/d/1YeITEX78l9exIm7GGdtHyQlfL9xclAhT/view
• Zoom: https://it.umn.edu/self-help-guides/zoom-teach-meet-learn-zoom
• Zoom HCC account: https://it.umn.edu/services-technologies/how-tos/zoom-hcc-non-hcc-accounts
• Technical assistance: National Consortium of Telehealth Resource Centers
• Adele Dimian ([email protected]), Jessica Simacek([email protected])
Pivoting with telehealth: Taking U of M
outreach, research, and training online
Jessica Simacek, [email protected], ICI Telehealth Lab Research AssociateInstitute on Community Integration
Institute on Community Integration
College of Education and Human Development
Objectives Barriers to intervention,
training, resource access
Telehealth for outreach: Reimagine your project
How to’s
Telehealth as a tool to deliver outreach and training
Improving rapid access to early intervention for children with autism
Increasing prevalence of autism
Lack of providers, healthcare/funding
Delays, waitlists, unavailability of services
Greater disparities for children in geographic regions and culturally and linguistically diverse groups
Children with complex communication needs, greater specialty of providers
New potential access issues
These barriers existed pre-pandemic, likely worsened due to current situation.
New potential access issues:
1. Intervention disruption (across multiple services)2. Greater family and child stressors 3. Children not being identified
Telehealth as an innovation to intervention delivery
Generalization &
maintenance
Increase intervention
intensity
Train interventionist across settings
Earlier intervention
Using telehealth to improve access to early intervention
Developmental concern
Diagnosis
Early intervention
Delay approx. 9to 12 months
Delay approx. 6 to 9 months
Link with evaluation clinics
Simacek, J. & Dimian, A., F.
Early intervention outreach & research with synchronous tele: How to
• Screening for safety– Does the child engage in challenging behaviors that may be deemed
severe or dangerous?• Assessment
– 1st by phone, then by observation via tele• Equipment (hardware)
– What does the end-user (family) have/need?• Tele-on-boarding
– Practice session, use link, camera/sound on/off, tech support• First sessions
– Free play, child and family-centered implementation • Intervention
– Prioritize (communication), short & frequent, routines-based (minimum “extra stuff” needed)
Improving regional capacity in person-centered and positive behavior supports in Minnesota: telePBS
Cohort 2 ASt. Louis County RegionCounty & Organizations
Cohort 2BWest CentralCounties, Public Health Dept., OrganizationsIntegrated Model
Cohort 1 & Cohort 4Support Development Associates Person-centered Practices ModelCounty, Organizations
Cohort 3 & 4
Southeastern
Counties, Public Health, Organizations
Minnesota Statewide Plan for Building Regional Capacity
Freeman, R., Simacek, J., & Hewitt, A..
PBSTertiary Tier
Universal Tier
Secondary Tier
Series of 6-day PBS Intensive trainings and focused workshops: Webinar
telePBS organization-specific visits 1-3 annual visits w/ U of M: Synchronous visits
Online learning materials and resources provided: https://mnpsp.org/
Tele for State outreach and capacity building: How to
Telehealth application
type:
SynchronousAsynchronous Combination
On-board:
tele-providersend-users
Implement:
Tele to enhance the
modelWhat should return to in-
person, what should remain
teleCollect data
Settings:
Fully remoteEnd-user remote
Satellite site (community
location)
Monitor:
Fidelity & qualityBoosters & additional resources as neededBuild towards sustainability
But, I do national/international outreach, training, or research
• Great news!
– Tele applications have been successfully used to connect with, train, conduct research activities on a national and international level
• Of course, ensure your compliance with IRB, HIPAA and/or FERPA, etc.
• e.g., ICI Telehealth Lab currently supports data collection for a specific tele-based measure across states in a multi-site study
• e.g., Hyde et al. (2020) increased study enrollment tenfold by moving study procedures remote (national recruitment)
Hyde, C., Pizzano, M., McDonald, N. M., Nelson, C. A., Kasari, C., Thiele, E. A., & Jeste, S. S. (2020). A telehealth approach to improving clinical trial access for infants with tuberous sclerosis complex. Journal of Neurodevelopmental Disorders, 12, 1-7.
Recommendations for pivoting to telehealth for outreach
• Look at current models, what can be improved?– Consider barriers people experience to accessing intervention,
training, knowledge resources• National Consortium of Telehealth Resource Centers:
https://www.telehealthresourcecenter.org/• Considerations for safety, privacy, and compliance• Platforms
– Complaint & User-friendly • Get familiar w/ video conferencing
– remind people when on/off mute/video, about privacy, etc.– Large groups (webinars) limit sound/video options of attendees– As for yourself & your team, act as if your sound/video is always on!
If your team has telehealth questions or needs, please reach out
Jessica Simacek, [email protected]
Adele Dimian, [email protected]
The Effects of Functional Communication Training Coached via Telehealth for Individuals with Rett SyndromeJennifer McComas, Rebecca Kolb, Shawn GirtlerAlefyah Shipchandler, & Emily Unholtz-BowdenUniversity of Minnesota
This study was funded by NIH/NIDCD Grant No. 1R21DC015021.
Rett syndrome• Rare neurodevelopmental disorder (approx. 1 in 10,000 –
15,000 females)
• Affects almost exclusively females
• Typical early development slowing of development loss skills (apraxia) – motor (apraxia)– speech
• Severity differs on individual basis
Retrieved from: https://reverserett.org/newly-diagnosed/#clinics-map
Research Aims
1. Esablish/increase early formal expressive communication skills
– With a parent-implemented assessment and functional communication training (FCT)
– Across several contexts/routines in natural environment
2. Examine feasibility of telehealth for coaching these skills
Research Design
• Single- case designs• Based on individual cases
–Adapted multiple-probe design–Reversal design
Participants• 19 individuals with Rett syndrome (95%
female)
Ages at onset
of study:
Mean = 10 yrs old Range: 18 mo - 29 yrs
Motor: 68% ambulatory (including with walker)
58% self-feed (some using fingers only)
Communication
Responses
Idiosyncratic: vocal sound, cry, reach, & look
Target: eye pointing 16%
picture cards/ touch-screen speech-generating device
21%
microswitch 53%
eye-gaze speech-generating device 37%
1
Interviews: Inventory of Potentially Communicative Acts (IPCA), FunctionalAssessment Interview (FAI)
2Structured observations and Preference Assessment (PA)
3Intervention: Functional communication training (FCT; experimental analysis)
Telehealth Rett Outcomes
Acquisition & Social Acceptability
Acquired 1 Message 100%
Acquired 2+ Messages 77%
Discrimination 26%
Page Linking 21%
Caregiver Acceptability Ratings
(1-7 Scale)M = 5.6 (r = 3 - 7)
