By using telemedicine and telehealth models, the Vanderbilt Kennedy Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) and the Intellectual and Developmental Disabilities Health Care Toolkit (IDD Health Care Toolkit) are reaching underserved areas, advancing quality service delivery, and improving clinicians’ ability to care for adults with intellectual and developmental disabilities.
Telemedicine, a means of providing remote diagnosis and treatment through telecommunications technology, has been around since the 1950s. While physicians 60+ years ago were using the telephone to expand their services and to collaborate with distant specialists, today, physicians and consultants have access to sophisticated software and video technology that assists in mirroring the in-person delivery of clinical services.
Like telemedicine, telehealth can refer to remote clinical service delivery, but it also can describe management and education activities such as remote provider trainings, consultations, and continuing medical education for providers.
Both telemedicine and telehealth are shifting the ways that providers are able to deliver services and are opening virtual clinic doors for underserved geographic areas.
Telemedicine at TRIAD
Two years ago, TRIAD Director Pablo Juárez, M.Ed., BCBA, began to drive his team’s exploration and implementation of technological platforms to improve and to expand how and where TRIAD was able to offer services for individuals with autism and their families.
Concerned with “service deserts” in Tennessee, Juárez wanted to meet a community need while also being mindful of the challenges associated with traveling long distances. After a period of research and consultation with colleagues, TRIAD now uses technology for remote service delivery in their school-based work, led by John Staubitz, M.Ed., BCBA, and in their work in early identification and intervention, led by Alacia Stainbrook, Ph.D.
“We are using telemedicine to provide rapid remote diagnostic screening evaluations for young children who may have autism spectrum disorder,” said Stainbrook. “Primarily, we are doing this in West Tennessee, which historically has been underserved. We have clinical space at the Ayers Clinic in Jackson, where families will come in to see a consultant in person. At the same visit, a psychologist, who is remotely present using our technology, is there to observe, to conduct an interview, and potentially to provide a diagnosis. This is proving to be a much faster and highly effective model.”
To confirm its effectiveness, TRIAD is running a separate validation study. The researchers have families come in person for a traditional, full evaluation with a psychologist. Just prior to this, the same family will have participated in a rapid remote evaluation facilitated by a psychologist using telemedicine. Preliminary results are very promising.
“We are confident that diagnosis through telemedicine is a valid method of assessment,” said Stainbrook. “And if there are concerns raised by the families being served or by the psychologists conducting the assessments, we have the option of bringing in the families for in-person visits. Satisfaction levels have been high, and we are thrilled to be able to see more families, especially in West Tennessee, where 60% of the families we see would not have had the capacity to travel to Nashville for a diagnosis. That means their children likely would have gone unidentified until they entered school.”
In addition, the TRIAD Early Intervention team is using the technology to deliver consultation and support to families through two clinics in rural Middle Tennessee. The clinics are equipped with the telemedicine technology. TRIAD consultants are able to connect to those sites and provide coaching and feedback to parents and their early intervention providers while they are conducting early intervention sessions.
TRIAD’s school-based services help teachers, administrators, and other stakeholders develop and evaluate programs, policies, and procedures, as well as design optimal behavioral and educational interventions for individual students with autism. Staubitz and others are providing behavior-focused assessments and professional development consultations remotely and are improving not only the numbers of people they are able to serve, but also are improving the quality of their services.
“The technology is allowing us to improve our services in a number of ways,” said Staubitz. “We can check the implementation of strategies through remote observations, both before and after trainings or in-person consultations. We can also conduct assessments in person and benefit from having an extra set of expert eyes watching a situation play out in a classroom from a remote location. If you think about it, that is a big deal.
“In the past, if I wanted to access another team member’s expertise, it would have been me trying to describe what happened in an email or over the phone, and her having to rely on my skills as a reporter to provide feedback on something after the fact. It would have been impossible for me to ask for half of her day from her own case load or project to travel to a classroom 100 miles away. It’s a totally different story today to have one of our speech-language pathologists give me 15 minutes to click into a visit where I am or even a remote visit I’m conducting and give that expert feedback. This technology has great implications for improving the intensity and quality of the way we are able to deliver services.”
Confident and enthusiastic about growing the VKC telepresence, TRIAD staff have developed tele-toolkits, replete with technology and instruction manuals, in the hope that more programs within the VKC will expand in this way. Plans for developing a replication model for the remote diagnosis of autism also are underway.
Telehealth and the IDD Health Care Toolkit
The IDD Health Care Toolkit, a project of the Vanderbilt Kennedy University Center for Excellence in Developmental Disabilities (VKC UCEDD), is a website that offers health care providers best-practice tools and information regarding specific medical, mental, and behavioral health concerns of adults with intellectual and developmental disabilities. In 2016, the toolkit expanded into the area of case-based telehealth trainings thanks to a grant from the Special Hope Foundation.
“We developed the telehealth trainings to further enable providers to work with people with intellectual and developmental disabilities and build upon the content provided through the IDD Health Care Toolkit,” said Janet Shouse, IDD Health Care Toolkit program coordinator. “Using remote technology, providers present cases to a panel of experienced clinicians in internal medicine, family medicine, psychiatry, neurology, psychology/behavioral health, and nursing to obtain practical advice on how to manage health concerns in individuals with intellectual and developmental disabilities.”
“During the 10 hour-long sessions, we also provide presentations from our panelists on topics like sleep disorders, psychotropic medication management, and the Employment and Community First CHOICES program, which complement the cases. The use of technology has allowed busy clinicians to take only brief time away from their practices, while still being present in their offices. We also worked with the Vanderbilt University Medical Center’s continuing education office to offer continuing education credits to participants. They have been very complimentary of the content and structure.”
Twenty physicians and advance practice nurses participated in the project, which ended in February. Shouse says they designed the telehealth trainings so that community health care providers would be better equipped and more comfortable caring for adults with intellectual and developmental disabilities. In effect, the hope is that patients would receive better and more timely care, and receive appropriate preventive care.
Shouse also said that the trainings were designed with the hope that this would reduce the number of patients who need to rely on hospital emergency departments or specialists for routine care, and would reduce the rate of polypharmacy, in particular the use of psychotropic medications.
“Building upon the success of the IDD Health Care Toolkit, we continue our efforts to improve access to quality health care for individuals with disabilities,” said Elise McMillan, co-director of the VKC UCEDD. “Using the telehealth model has been a truly effective way to address health disparities and to add to the growing and impressive telepresence of Vanderbilt University Medical Center.”
Courtney Taylor is VKC associate director of Communications and Dissemination
Pictured top of page: TRIAD telemedicine is used to assist with autism assessment and early intervention in Tennessee communities.