CEHD Remote Research Roundtable: Applications of Telehealth Approaches

for Research and Training

An overview of telepracticeAdele Dimian, Ph.D. (dimia006@umn.edu)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 (dimia006@umn.edu), Jessica Simacek(sima0034@umn.edu)

Pivoting with telehealth: Taking U of M

outreach, research, and training online

Jessica Simacek, PhDsima0034@umn.eduDirector, 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, PhDsima0034@umn.edu

Adele Dimian, PhDdimia006@umn.edu

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)