CARD researchers develop instrument to measure treatment integrity of behavior therapy delivered via telehealth to patients with autism

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The leader in ABA therapy since 1990.

The TTTIM is the only published instrument designed to measure the processing integrity of direct ABA services delivered through telehealth. The TTTIM instrument is composed of 44 elements which can be evaluated via telehealth.

Researchers at the Center for Autism and Related Disorders (CARD) developed the Telehealth Therapy Treatment Integrity Measure (TTTIM), an instrument designed to measure the treatment integrity of Applied Behavior Analysis (ABA) therapy delivered to patients via telehealth with Autism Spectrum Disorder (ASD). With the closure of many behavioral health clinics at the onset of the COVID-19 pandemic, many behavioral treatment services have shifted to telehealth, with practitioners performing behavioral therapy with patients remotely using video conferencing.

For patients with ASD, treatment interruptions can lead to blockages in progression and even regression of skills. In order to ensure continuity of patient services during the pandemic, many practitioners have started using telehealth to provide direct ABA therapy, some for the first time.

“The rapid transition to telehealth services was necessary for the health and safety of patients and clinicians,” said Karen Nohelty, M.Ed., BCBA, CARD Research Director. “Nonetheless, treatment providers who use telehealth have an ethical obligation to ensure that their practitioners are trained to deliver telehealth therapy and that their performance is regularly evaluated to ensure the integrity of treatment.”

There are many challenges and considerations unique to the delivery of direct therapy through telehealth. Many aspects of effective treatment, such as the caregiver’s role in treatment, relationship building with the patient, managing challenging behaviors, and promoting engagement, need to be approached differently when using telehealth versus in-person services.

“Very few resources are available for clinicians who are entering telehealth for the first time,” said CJ Miyake, M.Ed., BCBA, Director of Research. “We developed the TTTIM to help clinicians assess the quality of their patients’ telehealth services during this public health crisis.”

The TTTIM is the only published instrument designed to measure the processing integrity of direct ABA services delivered through telehealth. The TTTIM instrument is composed of 44 elements which can be evaluated via telehealth. Objectives of the measurement include training orientation on telehealth therapy procedures, self-assessment, and ongoing performance measurement. The TTTIM is available free of charge in an open access peer-reviewed journal article by Nohelty et al. (2021).

The COVID-19 pandemic is having the greatest effect on vulnerable populations, including people with ASD. CARD researchers reoriented their efforts to ensure that patients with ASD would continue to access effective treatment during the crisis. TTTIM was developed to promote quality assurance of treatment, but researchers expect its usefulness to continue after the health crisis, as telehealth has so much potential in treating autism. .

The references

Nohelty, K., Hirschfeld, L., & Miyake, CJ, (2021). A measure to support the implementation of direct telehealth therapy with the integrity of the treatment. Analysis of behavior in practice. https://doi.org/10.1007/s40617-020-00543-7

About the Center for Autism and Related Disorders (CARD)

CARD treats people of all ages diagnosed with Autism Spectrum Disorder (ASD) in treatment centers around the world. CARD was founded in 1990 by autism expert and clinical psychologist Doreen Granpeesheh, Ph.D., BCBA-D. CARD treats people with ASD using the principles of Applied Behavior Analysis (ABA), which has been empirically proven to be the most effective method for treating people with ASD and recommended by the American Academy of Pediatrics and the US Surgeon General. CARD employs a dedicated team of skilled professionals across the country and abroad. For more information, visit centerforautism.com.

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