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Overview of Telehealth & Technology for Individuals with ASD and Their Families Dr. Lou Overview of Telehealth & Technology for Individuals with ASD and Their Families Dr. Lou Vismara Consultant, Sen. Darrell Steinberg louis. [email protected] ca. gov Ph: (916) 651 -4189 Fx: (916) 327 -8867 1

Technology & Innovations in the ‘Digital Age’ Definitions and Concepts • • • Interactive Technology & Innovations in the ‘Digital Age’ Definitions and Concepts • • • Interactive Distance Education (case conference; didactic; training; virtual “hands-on”) Asynchronous Distance Education (lectures; pre-recorded information) Web-based Information Asynchronous “Store-and-Forward” (images; data; evaluations; audiovisual clips) Remote Communications Registries & Data Management Implementation: Planning & Strategic Approaches 1. 2. 3. 4. 5. Resource & need assessment Strategic & operational plan for technology-based program Evaluate “technology” and other telehealth platforms Integration of “technology” with other programs & services Information evaluation & outcomes assessment 2

How are technology and innovations being used in today’s healthcare environment? Tele-Healthcare (categories) Real-time How are technology and innovations being used in today’s healthcare environment? Tele-Healthcare (categories) Real-time Interactive Services Remote Monitoring Store-and-Forward General health care delivery Ø Ø Ø Ø Electronic Health Records Health Information Exchange Clinical decision support Clinical Education Patient Support & Education Pharmacy & laboratory systems Electronic medical records Disaster response support Specialist care delivery Experimental services 3

Quick Facts about Tele-Healthcare: 77% of families have internet access 80% of internet users Quick Facts about Tele-Healthcare: 77% of families have internet access 80% of internet users gather health information online (specific diseases; treatments; doctors; hospitals) Underutilized: < 10% of California consumers ~ telehealth session Only 13% of medical practices use electronic health records V. A. telehealth program for vets with chronic conditions reduced hospital admissions by 19% and total bed days of care by 25% California prisons provided 9, 000 telehealth consultations : >$4 M savings Diabetes outpatient visits reduced by 49% Congestive heart failure hospitalization costs reduced by 47. 5% Tele-medicine annual savings: $4. 2 B nationally; $511 M California 4

What are impacts of technology and innovations on today’s healthcare outcomes? • Increases access What are impacts of technology and innovations on today’s healthcare outcomes? • Increases access to healthcare services • Improves healthcare outcomes • Reduces healthcare costs • Improves disparities in providers • Improves training & education of providers • Improves supports for patients & families • Improves organizational productivity • Helps the environment 5

Why do we need innovative programs for the evaluation and treatment of ASD? Increased Why do we need innovative programs for the evaluation and treatment of ASD? Increased demand for autism services Autism = 1 in 110 (>70% increase from prior 2002 Limited number professionals (<5, 000 BCBA~ASD experience) Limited collaboration and integration Unclear treatment paths & responsibilities Disparities in services Parents & caregivers are often “traumatized” Shrinking budgets “insanity”: keep doing the same thing and expect a different outcome

Overview of Assistive Technology & ASD (“Telepractice Review” by M. Boisvert; Developmental Neurorehabilitation, Dec. Overview of Assistive Technology & ASD (“Telepractice Review” by M. Boisvert; Developmental Neurorehabilitation, Dec. 2010; 13(6) 423 -432) Definition: Any item, equipment, or product that is used to increase, maintain, or improve functional capabilities of individuals with ASD Functional Classification Ø Communication skills Ø Social interaction skills Ø Attention skills Ø Motivation skills Ø Organizational skills Ø Academic skills Ø Self-help skills Ø Independent daily functioning skills Ø Understanding of environment Delivery of Services & Programs No discussion of facilitated or augmented communication 7

The U. C. Davis MIND Institute Applications of Technology & Innovative Programs A parent-founded The U. C. Davis MIND Institute Applications of Technology & Innovative Programs A parent-founded & inspired research institute dedicated to finding: the cause(s), better treatments and ultimately a cure(s) for autism and other neurodevelopmental disorders Includes 48 senior researchers &faculty, 86 research fellows 38 major research projects 270 employees 160 volunteers

U. C. Davis Center for Health Technology www. ucdmc. ucdavis. edu/cht/ “Enhancing Mental health U. C. Davis Center for Health Technology www. ucdmc. ucdavis. edu/cht/ “Enhancing Mental health Services for Children with ASD in Rural Communities” www. media. americantelemed. org/conf/2008/Presentations 1. Overview of Telehealth 2. Tertiary care center & target communities 3. Practical considerations for implementation of services 4. Telehealth-enabled ASD training/services 5. Principles of culture, ethics, legal & professional considerations Recommendations for Reviewing Websites: q q q Authority Accuracy Objectivity Comprehensive & inclusive Current & Up-to-date 9

The MIND Institute Early Start Denver Model Lab Mission of the ESDM Program • The MIND Institute Early Start Denver Model Lab Mission of the ESDM Program • • To understand patterns of growth and change in young children with ASD & other disorders. To prevent or minimize the disability through early detection, early intervention, and family support. To prepare for careers in research & clinical care To increase public awareness and knowledge Research Projects • • • Intensive Treatment for Toddlers with Autism (Early Steps) Initial Investigation of Prevention of ASD in Infants at Risk (Infant Start) Remote ESDM: Expanding the Reach of Toddler. Treatment in ASD 10

The MIND Institute Early Start Denver Model Distance Intervention Project Based on ESDM curriculum The MIND Institute Early Start Denver Model Distance Intervention Project Based on ESDM curriculum & teaching approach (attention; motivation; sensory-social; play; dyadic; non-verbal & verbal communication; imitation; speech) Computers/laptops web cameras Initial evaluation; specific goals; 12 week program Video conference parent training: 1/hour/week (review; parent-child play; feedback; new skill; practice) Final Assessment & Comparison with Center-Based Therapy 11

Results of the MIND Institute ESDM Distance Intervention Program • High degree of fidelity Results of the MIND Institute ESDM Distance Intervention Program • High degree of fidelity (6 hours) • High degree of parental satisfaction • Wider range of observed activities • Achieved 95% of goals • > joint attention, social & shared interests • Verbal: (spontaneous) pre=3. 44/ post=29. 9 (prompted) pre=3. 87/ post=9. 43 • Vocabulary: pre= 107. 6/post=237. 1 • Adaptive behavior (Vineland) pre=77/post=82 • No differences from center-based therapy 12

THE MIND INSTITUTE ESDM QUALITY OF PARTICIPATION & OUTCOMES INVOLVES: Enthusiasm to participate Amount THE MIND INSTITUTE ESDM QUALITY OF PARTICIPATION & OUTCOMES INVOLVES: Enthusiasm to participate Amount of practice between sessions Child’s Quality of response to parent-child parent sharing Parentchild success Buy in to approach & goals Confidence in delivering the information

Parents Click on Selected Topic Parents Click on Selected Topic

The MIND Institute Virtual Reality Lab Dr. Peter Mundy PRELIMINARY STUDY: • 3 -D The MIND Institute Virtual Reality Lab Dr. Peter Mundy PRELIMINARY STUDY: • 3 -D simulated classroom • Nine avatar peers • Multitasking activities • Controlled interventions PRELIMINARY RESULTS: • Joint attention~learning • Joint attention improves >age • Joint attention delayed with HFA • Joint attention/HFA improved post virtual training 15

The U. C. Davis MIND Institute www. ucdmc. ucdavis. edu/mindinstitute/ MIND Videos Distinguished Lecture The U. C. Davis MIND Institute www. ucdmc. ucdavis. edu/mindinstitute/ MIND Videos Distinguished Lecture Series Minds Behind the MIND Lecture Series Summer Institute on Neurodevelopmental Disorders Special Lectures and Conferences MIND Educational Videos In the Community Videos By Topic RESOURCES Disabilities and Conditions Advocacy Development Education Health & Wellness Local, State, & Federal Regional Centers Speech & Language Support Groups Other Services Adulthood & Transition Assistive Technology Early Intervention Family Resource Centers International Resources Occupational Therapy Research Sports & Recreation Videos-MIND Institute 16

The MIND Institute Tele-Autism Program Major Goals & Objectives 1. Technology based “system of The MIND Institute Tele-Autism Program Major Goals & Objectives 1. Technology based “system of care” for ASD 2. Access, comfort, efficacy, and satisfaction (clinical & research) 3. Establish “telecompetence” Ø Video-conferencing Ø Multi-media platforms Ø Written/video learning modules Ø “Store & forward” technology Ø Data management & Multi-disciplinary communication Ø Communities of practice Ø Resource information center Ø New therapeutic modalities 17

Computer-Assisted Interventions Software programs Ø Drill & practice Ø Tutorial Ø Improved language & Computer-Assisted Interventions Software programs Ø Drill & practice Ø Tutorial Ø Improved language & social interactions Ø Increased motivation Ø Off-computer activities Keys to success Ø Ø Ø Predictability Animation Multiple exemplars Variety in methods Non-repetitive trials Customization Possible pitfalls: Ø Generalization Ø Boredom &/or frustration Ø Limited research 18

Autism Learning Platform 19 Autism Learning Platform 19

Examples of Proprietary Companies Teach. Town Corp. Software treatment ABA program – Over 500 Examples of Proprietary Companies Teach. Town Corp. Software treatment ABA program – Over 500 lessons for children – video game rewards Platform for synchronization between home and school and therapists office; progress reporting, communication/notes Tools for rapid development of new content Expert mode to customize curriculum Animated Speech Corp. 20 Team Up with Timo is a language learning suite that features an engaging animated tutor to teach – Vocabulary lessons – Stories and related games to teach narrative skills and language in context Lesson Creator: – A tool for teachers, parents and therapists to create individualized vocabulary lessons Lesson Exchange: enables posting and exchanging of lessons

What Does Teach. Town Offer to Classrooms? Teach. Town products teach academic & social What Does Teach. Town Offer to Classrooms? Teach. Town products teach academic & social skills required to be successful in Pre-K, Kindergarten and 1 st grade Teach. Town: Basics • A research-based, computer-aided instructional software program • Uses evidence-based best practices from Applied Behavior Analysis (ABA) • Includes 500 on computer lessons with 300 highly motivating off computer activities to promote generalization • Teaches thousands of concepts that improve performance in six key learning domains Teach. Town: Social Skills • A video modeling-based curriculum • Infuses engaging animated characters that teach socially valid skills in each episode • The targeted skill in each episode is further developed through a series of lesson plans, classroom activities, and homework assignments • The animated characters become another voice in the classroom to support teachers

What is the Scientific Data to Support Efficacy? A US Department of Education funded What is the Scientific Data to Support Efficacy? A US Department of Education funded study with LAUSD: During this 3 -month study Teach. Town students had significant gains compared to control groups

Web-based Curriculum & Technology ü Standardize the delivery of research-based services ü Provide training, Web-based Curriculum & Technology ü Standardize the delivery of research-based services ü Provide training, collaboration & supervision across multiple staff, families and geographic locations ü ü Multi-media & interactive formats Supplements existing resources ü Cost-effectively manage the increased demand ü Proprietary Companies Rethink Autism (www. rethinkautism. com) Center for Autism & Related Disorders (www. centerforautism. com) 23

TECHNOLOGY TO TRAIN PROFESSIONALS CARD e. Learning™ is a 40 -hour online training course TECHNOLOGY TO TRAIN PROFESSIONALS CARD e. Learning™ is a 40 -hour online training course designed to facilitate effective intervention for children with autism. Completely web based. • • Tool for training therapy staff Teaches ABA procedures for treating autism Narrated presentations provideo demonstrations Self-guided and go at your own pace Online note taking Quizzes track progress of each module Passing final exam results in a certificate of completion Continuing education units available for this training

Technology to Assess & Treat ASD Skills™ is a treatment management program for comprehensive Technology to Assess & Treat ASD Skills™ is a treatment management program for comprehensive assessment, curriculum, and progress-tracking. • • Assessment with age milestones 4, 000 lesson activities and tens of thousands of targets Covers all areas of child development Assessment links directly to customizable lesson plans Includes printable materials, worksheets, and data sheets Tracks/Graphs assessment results and treatment progress Multidisciplinary approach allows the entire treatment team to evaluate the effects of other treatments, life events, and challenging behaviors on child progress 26

Synchronization between multiple systems of care Child Data Home 27 Authoring System Clinic or Synchronization between multiple systems of care Child Data Home 27 Authoring System Clinic or School

There is an “App” for that Application software, also known as an application or There is an “App” for that Application software, also known as an application or an "app", is computer software designed to help the user to perform specific tasks App manipulates text, numbers, or graphics Classification of apps: Ø Ø Ø Ø Information worker (accounting programs) Content access (web browser; media player) Entertainment (video games) Educational (references; learning software) Enterprise infrastructure (database; business workflow) Simulation (flight; driving; emergency) Media development (editing; animation; simulation; 3 -D) Product engineering (design; program testing; editing) Over 140, 000 apps for i. Pad (“work, play, & everything in between”) Google search “autism app”: >10, 700, 000 results 28

General classification of autism “apps” Ø Speech; language; communication Ø Basic Education Ø Specific General classification of autism “apps” Ø Speech; language; communication Ø Basic Education Ø Specific learning tasks Ø Visual learning Ø Augmented communication devices Ø Data collection; behavioral therapy supports Ø Social skills Ø Improve eye contact & physical skills Ø Schedules & transitions Ø Games and fun Ø Caregiving Ø Miscellaneous 29

Autism “Apps” Websites: www. autismepicenter. com www. modelmekids. com www. squidalicious. com www. itunes. Autism “Apps” Websites: www. autismepicenter. com www. modelmekids. com www. squidalicious. com www. itunes. apple. com/us/app/autism www. snapps 4 kids. com www. hackingautism. org 30

Hacking Autism Website: “Idea Gallery” www. hackingautism. org Examples of >300 concepts submitted Health Hacking Autism Website: “Idea Gallery” www. hackingautism. org Examples of >300 concepts submitted Health / Wellness: Job chart or progress chart. Check list of chores and tasks. Basic tutorials on brushing teeth, potty training, buckling seat belts, crossing the street, etc. Behavioral: an app that teaches my autistic son to use his napkin and not his shirt - his fork and not his fingers. Also, one that teaches him to try a new food. . . can say ' no thank you' in a nice calm voice instead of saying 'NO EGGS!' in a loud, scary voice Basic Education: Handwriting app that allows them to trace letters and write whole sentences - not just a flashcards app. Speech / Communication: An app that helps reinforce spoken and sign vocabulary and share by particular sign variants, gestures and behaviors with caregivers. Fun: i would like to see an app that would not only be fun but would teach a child with autism basic everyday skills like dressing or potty training or how to deal with crowds and situations that they may face day to day 31

Program Flowchart TPSID Grant: Jeff Ross Ipad 2 Lead: Joe’ll Chaidez Educational Use: Accommodation Program Flowchart TPSID Grant: Jeff Ross Ipad 2 Lead: Joe’ll Chaidez Educational Use: Accommodation Specialists Social Use: Accommodation Specialist/ Field Supervisors Assessment/ Outcomes: Joell Chaidez TPSID Grant: Jeff Ross Vocational Use: Career Coaches/ Field Supervisors

 Applications Academic Applications Vocational Applications ØClass Scheduler ØAudio Books ØEBooks ØMy Math Flash Applications Academic Applications Vocational Applications ØClass Scheduler ØAudio Books ØEBooks ØMy Math Flash Cards ØMath Racer ØCampus Life ØStudy Aid ØStudy Buddy ØHome Work Tracker Ø Writing Tips ØComplete Class Organizer ØResume Generator ØSkype ØInterview Pro ØCareer Builder ØJob Coach ØMonsterjobs ØClassifieds 2 go ØCareer Jet ØStyle Tips ØIpad Mirror ØDress to Impress ØEtiquette Pro ØTwitter ØBizz. Bites Social Applications ØFacebook ØFandango ØSkype ØTouch Trainer ØFubar ØTwitter Øoo. Voo Video chat ØGrocery Pal ØBill Reminder ØHours Tracker ØAce Budget ØDating DNA ØDating Ideas ØMeal Planner ØGot Questions

Integration & Implementation Monthly Meeting Field Supervisors bring feedback to monthly meetings. Students give Integration & Implementation Monthly Meeting Field Supervisors bring feedback to monthly meetings. Students give feedback. Ask students to find new apps. Review/ Update Introduce new apps Integrate/Use the new applications. Field test

Innovations for ASD & Behavioral Sciences Ø Behavior Capture ™ Ø Behavior Connect ™ Innovations for ASD & Behavioral Sciences Ø Behavior Capture ™ Ø Behavior Connect ™ Ø Telemetric monitoring Ø EEG & other brain monitoring systems Ø Automated facial expression detection systems Ø Real-time data & pattern recognition algorithms Ø Autonomic nervous system monitoring 36

Applying Futuristic Applications to the Diagnosis & Treatment of ASD EMR Video Capture Multimedia Applying Futuristic Applications to the Diagnosis & Treatment of ASD EMR Video Capture Multimedia Medical Record physiologic monitoring & data feedback This will be the wave of the future Change is going to come

Autism, Technology, & Public Policy SB 946 (Steinberg): Autism Behavioral Treatment Health Insurance Mandate Autism, Technology, & Public Policy SB 946 (Steinberg): Autism Behavioral Treatment Health Insurance Mandate AB 415 (Logue): Telehealth Advancement Act • • • Updates terminology Includes asynchronous (store & forward) Includes email & telephone services Provides for telehealth coverage of services Eliminates “barrier” requirement Eliminates “informed consent” requirement SB 764 (Steinberg): Autism Telehealth Program 38

Adapting Innovations in the ‘Digital Age’ to Improve the Lives of Individuals with ASD Adapting Innovations in the ‘Digital Age’ to Improve the Lives of Individuals with ASD & Other Learning Differences “Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has. ” Margaret Mead “The only constant in life is change” The End