The shift to online learning in the past year has presented significant challenges for children and families, especially for autistic children who often struggle with changes in routine and the engagement required for remote instruction.
Brooke Ingersoll, a professor of psychology at Michigan State University and director of the MSU Autism Lab, has worked closely with providers throughout the pandemic to ensure proper intervention methods were delivered to children with minimal interruption.
Recognizing these challenges and the stress on families, Ingersoll notes that the transition to remote learning and telehealth has also opened the door for some positive changes in service delivery for autism — by increasing access to services. She is hopeful that these positive changes will continue into the future, even after the threat of COVID-19 passes.
In her own words, Ingersoll describes three areas of concern for autism education going forward.
Intervention methods
“So much of the success for a child with ASD comes from what they learn, practice and experience in the home — without specialists guiding them. Parent coaching, which equips caregivers with the tools to help children develop and learn, is a specific area of my research. Although parent coaching has a strong evidence-base for improving child and caregiver outcomes, it has been highly underutilized in community-based intervention programs.
“COVID restrictions have forced many providers, especially those working with young children and children with more intensive needs, to use a parent coaching model, which lends itself very well to telehealth.
“Even before COVID, my colleague Anna Dvortcsak — a speech language pathologist — and I were studying the effectiveness of telehealth options for parent coaching, so we had a body of research to support us as the entire world shifted to remote operations.
“We saw the opportunity to put our research into practice and launched parent coaching videos on YouTube to help providers who had to shift to remote service delivery learn how to provide quality parent coaching over telehealth.
“Since telehealth doesn’t require the provider to travel, it helps increase accessibility and provides cost-savings. By allowing intervention to occur in a family’s home, it can also give the provider a glimpse into the routines and environment of the household.
“And since travel is not required, it may allow the traditional clinic model of one-hour sessions to be redesigned to better fit a family’s needs. For example, young children may do better in shorter sessions; we’ve found two half-hour sessions per week work better for many families than the traditional one-hour session.”
“We see this as a positive shift in practice —now that providers are more consistently using parent coaching, providers and families are seeing its benefits. And, I anticipate that we will see continued use of this intervention approach, both in person and over telehealth even after COVID passes.”
Assessment and diagnosis
“Current diagnostic models often involve extended testing by a multidisciplinary team of professionals at a specialty clinic. These assessments usually involve long waitlists, extended travel to a specialty clinic for families and long days with multiple professionals. Being observed/assessed in an unfamiliar setting can be very stressful for children and families, which makes the process even more difficult.
“COVID restrictions have forced many diagnostic clinics to retool their assessment approach. Shifting to telehealth allows more opportunity for a ‘stepped care model’ in which some components of the assessment can be completed remotely over video conferencing, like Zoom. Some of these components include the caregiver interview, asking the caregiver to elicit specific skills of the child in a home environment for the assessor to observe while allowing multiple professionals to observe at the same time.
“There are certainly challenges involved in remote assessment for ASD, as some important information may be lost. But diagnosticians are learning that this approach can be viable and, in many cases, may generate sufficient information to provide a diagnosis. For more complex cases, a follow-up in-person assessment can be conducted as needed.
“This hybrid model makes the assessment and diagnosis process more accessible to families — especially those in underserved or remote areas.
Compliance
“Since its inception, the Health Insurance Portability and Accountability Act, known as HIPPA, has enforced stringent rules on health information sharing and communication, making telehealth options for ASD challenging.
“But since COVID hit and we have all been in the confines of our own homes, HIPPA has loosened restrictions to allow for continued care during social distancing.
“Providers, caregivers and children have benefited by having greater access to telehealth, for using more accessible learning software and on the administrative side, allowing for billing for remote services.
“These changes allowed more providers to jump in and try telehealth — which was key for getting people comfortable with this model. Many organizations have now retooled their software to allow for HIPPA compatible telehealth delivery, which opens the door for changes to benefit families in the future.”