As the population of consumers with autism syndrome disorder (ASD) increases—it grew 152% between 2000 and 2014—there is a corresponding need for new (as well as more efficient and effective) treatments and better business approaches. These new approaches were a key part of the discussion at The 2019 OPEN MINDS Children’s Services Leadership Summit on October 28, 2019 in Philadelphia (see Disrupting ASD Treatment: Opportunities & Challenges). While every program highlighted was unique, common themes included the need for technology-enabled treatment, early intervention, evidence-based approaches to staff training, and building capacity.
“There’s not much more margin you can squeeze out of clinical intervention, so [cost] efficiencies have got to come from back end infrastructure,” said Daniel Openden, Ph.D., BCBA-D, president and chief executive officer, Southwest Autism Research & Resource Center (SARRC). “We’re looking for ways to invest in technology to streamline the back end of our business so we can do things more effectively. Think about how you’re investing in your infrastructure so you can compete at some level” (see How Do You Compare On Tech Spending & Adoption?).
While every program highlighted was unique, common themes included the need for technology-enabled treatment, early intervention and evidence-based approaches to staff training, and building capacity.
Boyd H. Mark, director of telehealth services for The Scott Center, described telehealth as a technology whose time has come. The Center, a nonprofit organization on the Florida Tech campus, developed a free, online screening tool (www.screenourkids.org) to boost screening rates for all children as early as two years of age. The tool, which was launched 18 months ago, has 10,000 accounts. The Center also uses technology to diagnose and deliver care from iPads used in consumers’ homes to the use of cameras set-up in exam rooms to allow offsite health care providers to work with consumers. Technology enables faster treatment options that are scalable, Mr. Mark said.
“If we get to them [consumers with ASD] early, we can reduce the signs and symptoms, reduce costs, and help them lead healthier lives,” said Mr. Mark, who noted that if children with ASD receive treatment prior to elementary school, 50% of them are indistinguishable from peers. Without intervention that drops to 2%. “There is an enormous opportunity during a small window of time to screen, identify them and to take action,” Mr. Mark said. “It’s the phenomena of neuroplasticity—if we can reach these kids early, we can make a tremendous difference.”
That ability to influence brain development—called neuroplasticity—was illustrated by Dr. Openden, who shared examples of how early interventions with pre-school aged children diagnosed with ASD improves outcomes. Using video clips from The Community School, which SARRC runs, Dr. Openden demonstrated how positive interventions empower children with ASD to make socially accepted choices that prepare them for everyday life. The school, located in Phoenix, educates children with ASD and those without it with a three-to-one student-teacher ratio. Teachers rotate into different zones in the classroom to ensure kids are learning with people and materials that are most motivating to them. Kids move freely throughout the classroom and it’s the teachers who rotate to different zones.
The only difference between students with ASD and those without it is a 15-minute session with teachers per day. One byproduct of the integrated setting is increased empathy among “typically developing kids,” who benefit equally from the learning environment (as illustrated above) are more willing to help students with ASD. “It’s a larger return on investment and a bigger impact that we’re having on the rest of community” (see How Phoenix Became The Most Autism-Friendly City In The World).
The value of positive reinforcement was emphasized by Richard Allen, Psy.D., BCBA-D, NCSP, supervising psychologist and Todd Harris, Ph.D., executive director of autism services for Devereux Advanced Behavioral Health, who use Behavioral Skills Training (BST) to ensure consistent care delivery. Devereux serves 1,500 consumers with ASD (from diagnosis to geriatric stages) in 12 states with 7,000 staff members. Unlike the traditional, three-step training with didactic learning, BST has seven steps that focus on knowledge and skills using a four-to-one ratio of positive (four) to corrective (one) feedback to ensure staff implement techniques with fidelity.
Evidenced-Based Staff Training
Devereux uses telehealth to expand access to this training using Bluetooth software, earbuds, and cell phones that “allow us to help families far away” and work with staff who are remote and can access recorded trainings with interactive elements to demonstrate competency. “Most organizations know what treatment should look like but don’t know how to get that treatment implemented with fidelity over time,” explained Dr. Allen. “The challenge we face is that this approach takes more resources and time. There is usually a lot of drift in performance, and this continuous feedback helps address that.”
Effective and comprehensive training was key to ensuring that all services offered by Easterseals UCP North Carolina and Virginia—from health care to housing—are ASD-informed. The team built a bench of professionals—from behavioral analysts to technicians—to ensure a consistent approach that meets the needs of consumers with ASD and their families.
With 120 consumers with ASD to every board-certified behavioral analyst in North Carolina, the state has the highest unmet need, according to Lecia M. Anzaldo, MPA, BCBA, director of autism services for the organization. In response, Easterseals developed a career path to “grow their own” workforce. Creating career paths for autism technicians, assistant behavioral technicians, registered behavioral technicians, and BCBAs expands patient access and builds internal capacity and satisfaction. “We don’t get stuck in our model; we’re thinking more broadly and pulling the family in to support the individual as well as the entire family,” explained Ms. Anzaldo.
Presenters shared stories about health and lifestyle improvements that resulted from their innovative approaches and cited frustration with rigid reimbursement models that do not support telehealth in some cases or interdisciplinary approaches that yield results. Several health plan executives participating in the summit shared their thoughts on how case rates could address this issue (see Are Bundled Payments The Future Of Autism Reimbursement?).
For more on ASD and technology, check out these resources from The OPEN MINDS Industry Library:
- Another Boost in Autism Funding
- Autism Rates & Costs: A Future View
- Are You In A ‘Technology First’ State?
- Opportunities In The Autism Market Shift With More Managed Care
- One in 40 United States Children Has Autism Spectrum Disorder
- New Opportunities Serving Adults With Autism
- Annual Health Care Costs For Adults With Autism 55% Higher Than General Population
- Prevalence Of Autism Spectrum Disorder In U.S. Stable In Recent Years
- Designing & Implementing Innovative Treatment Programs: An OPEN MINDS Executive Summit & Showcase
- Considering Cash-& Consumerism-In Service Line Planning
And for even more on technology adoption, join us in Clearwater Florida on February 14 at The 2019 OPEN MINDS Performance Management Institute for the session, “The Future Of Residential Treatment: How Technology & Innovative Program Models Are Redefining Service Delivery Models” featuring Dyann Roth, President & Chief Executive Officer, Inglis.