- by Karelix Alicea, M.S., BCBA
I heart telehealth! It is unquestionably becoming one of the most useful and important communicative tools in the field of Applied Behavior Analysis (ABA). It has become one of my passions, not only because it makes my life so much easier, but also because it allows me to help more children at once. As a busy behavior analyst, business owner and doctoral student, I often find myself needing to be in two or even three places at the same time. Telehealth allows me the flexibility to conduct supervisions at a time that is most convenient for my hectic schedule. Some of you may thinking to yourselves, “Tele- what?”. Let me explain:
Telehealth involves the use of telecommunication mediums that allow for simultaneous visual (video) and audio (voice) capabilities. FaceTime, Skype and Google Hangouts might come to mind as popular telecommunication mediums that people use on a daily basis but, regarding telehealth, it gets a little more complicated than that. HIPAA is a real thing, remember? Telehealth can be synchronous (happens in real-time) or asynchronous (requires video recording and file sharing for later review). They each have their own pros and cons, but both most definitely rock!
Why Telehealth?
Because so many individuals suffering with autism don’t have access to our services. Although there are currently approximately 46,000 Behavior Analyst Certification Board (BACB) professionals working in the United States, the Centers for Disease Control and Prevention (CDC) estimated in 2014 that there are 3.5 million Americans diagnosed with autism spectrum disorder (ASD) living in our country alone, and approximately 750 million throughout the world. As of May 2017, the BACB analyzed 87 countries throughout the world, 65 of which have 10 or less BCBA-D, BCBA, and BCaBA practitioners combined, 60 of which have 5 or less, 51 of which have 3 or less, 43 of which have 2 or less, 31 of which have 1 or less, and 9 which do not have any professional ABA practitioners of any certification level. Furthermore, the countries of Azerbaijan, Egypt, Modolva, Nigeria and Trinidad & Tobago only have BCaBAs that must be remotely supervised by a BCBA or BCBA-D in order for their experience hours to count. In conclusion, the ability to provide remote ABA services is essential to both the growth of our field and to the population of individuals we service. Although telehealth is one of the best alternatives for reaching out to these clients, it is not a perfect alternative.
Sometimes the internet connection is slow. Sometimes the sound quality is not as clear as you wish it would be. Sometimes the device you are connected to runs out of battery. Sometimes uploading a video takes a lifetime. Sometimes the clinician and the client are on very different time zones. Sometimes the people attempting to communicate with one another are not extremely fluent in each other’s languages. But, nevertheless, you figure it out and you make it work. There are simple remedies for each of these drawbacks that you grow accustomed to preparing for ahead of time for those “just in case” moments. All in all, I say the good by far outweigh the bad.
Ethical considerations must also be taken when providing telehealth services, including any restrictions related to the client’s funding source. While most insurance carriers cover telehealth services, some do not. Some only allow parent training do be delivered remotely. Others only allow supervision. Different insurance carriers also use different terminologies. The terms telehealth, telemedicine, telemental health services, telepractice, and remote services are some of the most common terms used to describe the same practice. Believe it or not, most telephone representatives for commercial insurance carriers will not know what on earth you’re talking about when you mention the word telehealth and question whether or not it is a covered service under the client’s policy. They may ask you to spell it. They may even tell you they need to ask their supervisor and call you back.
Many families in search of help for their loved one with autism do not even know we exist. They don’t know who we are, what our field does or what our services are even called. They don’t know how much we love what we do or how much they would love us in return for having a such tremendous impact on their lives. Maybe you are a parent seeking services for your child…or perhaps you are a clinician looking to expand your practice, to help children from your native homeland overseas, or to work from home. No matter the circumstance, you can rest assured that telehealth rocks! The next time you mention the word telehealth and someone responds with “Tele- what?”, do us all a favor: give them the run down and tell them to get it on all the telehealth action to save the world, one country at a time, with behavior analysis!
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Karelix Alicea
I am a Board Certified Behavior Analyst (BCBA), an Infant Toddler Developmental Specialist (ITDS), and founder of Lotus Behavioral Interventions.
I am also the Executive Director of The Lotus Children (TLC), a 501(c)3 non-profit organization that funds ABA services and related resources for those who otherwise wouldn't be able to afford them. Lastly, I am the co-founder of Miami Association for Behavior Analysis (MiABA).
