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Overview of Telehealth


Overview of Telehealth & Technology for Individuals with ASD and Their Families Dr. Lou Vismara Consultant, Sen. Darrell Steinberg louis.vismara_at_sen.ca.gov – PowerPoint PPT presentation

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Title: Overview of Telehealth

Overview of Telehealth Technology for
Individuals with ASD and Their Families
  • Dr. Lou Vismara
  • Consultant, Sen. Darrell Steinberg
  • Ph (916) 651-4189
  • Fx (916) 327-8867

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
  • Resource need assessment
  • Strategic operational plan for
    technology-based program
  • Evaluate technology and other telehealth
  • Integration of technology with other programs
  • Information evaluation outcomes assessment

How are technology and innovations being used in
todays healthcare environment?
  • Tele-Healthcare (categories)
  • Real-time Interactive Services
  • Remote Monitoring
  • Store-and-Forward
  • General health care delivery
  • 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

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 lt 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 gt4 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

What are impacts of technology and innovations on
todays 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

Why do we need innovative programs for the
evaluation and treatment of ASD?
  • Increased demand for autism services
  • Autism 1 in 110 (gt70 increase from prior 2002
  • Limited number professionals (lt5,000 BCBAASD
    experience)Limited collaboration and
  • 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. 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
  • Communication skills
  • Social interaction skills
  • Attention skills
  • Motivation skills
  • Organizational skills
  • Academic skills
  • Self-help skills
  • Independent daily functioning skills
  • Understanding of environment
  • Delivery of Services Programs
  • No discussion of facilitated or augmented

The U.C. Davis MIND InstituteApplications 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 Technologywww.ucdmc
.ucdavis.edu/cht/Enhancing Mental health
Services for Children with ASD in Rural
  • Overview of Telehealth
  • Tertiary care center target communities
  • Practical considerations for implementation of
  • Telehealth-enabled ASD training/services
  • Principles of culture, ethics, legal
    professional considerations
  • Recommendations for Reviewing Websites
  • Authority
  • Accuracy
  • Objectivity
  • Comprehensive inclusive
  • Current Up-to-date

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
  • To prepare for careers in research clinical
  • 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

The MIND Institute Early Start Denver Model
Distance Intervention Project
  • Based on ESDM curriculum teaching
    approach(attention motivation sensory-social
    play dyadicnon-verbal verbal communication
    imitation speech)
  • Computers/laptops web camerasInitial
    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

Results of the MIND InstituteESDM Distance
Intervention Program
  • High degree of fidelity (6 hours)
  • High degree of parental satisfaction
  • Wider range of observed activities
  • Achieved 95 of goals
  • gt joint attention, social shared interests
  • Verbal (spontaneous) pre3.44/ post29.9
    (prompted) pre3.87/ post9.43
  • Vocabulary pre 107.6/post237.1
  • Adaptive behavior (Vineland) pre77/post82
  • No differences from center-based therapy

The MIND Institute ESDMQuality of Participation
Outcomes Involves
Quality of parent-child sharing
Parents Click on Selected Topic
The MIND Institute Virtual Reality LabDr. Peter
  • Joint attentionlearning
  • Joint attention improves gtage
  • Joint attention delayed with HFA
  • Joint attention/HFA improved post virtual training
  • 3-D simulated classroom
  • Nine avatar peers
  • Multitasking activities
  • Controlled interventions

The U. C. Davis MIND Institutewww.ucdmc.ucdavis.e
  • 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 Adulthood Transition Advocacy
    Assistive Technology
  • Development Early Intervention Education Fa
    mily Resource Centers Health
    Wellness International Resources Local, State,
    Federal  Occupational Therapy Regional
    Centers Research Speech Language Sports
    Recreation Support Groups Videos-MIND
    Institute Other Services 

The MIND Institute Tele-Autism ProgramMajor
Goals Objectives
  • Technology based system of care for ASD  
  • Access, comfort, efficacy, and satisfaction
    (clinical research) 
  • Establish telecompetence
  • Video-conferencing
  • Multi-media platforms
  • Written/video learning modules
  • Store forward technology
  • Data management Multi-disciplinary
  • Communities of practice
  • Resource information center
  • New therapeutic modalities
  • Process of adopting technology
  • Knowledge
  • Persuasion
  •  Decisions
  • Implementation 
  • Confirmation

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

Autism Learning Platform
Examples of Proprietary Companies
  • TeachTown 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.
  • 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 TeachTown Offer to Classrooms?
TeachTown products teach academic social skills
required to be successful in Pre-K, Kindergarten
and 1st grade
  • TeachTown 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
  • Teaches thousands of concepts that improve
  • performance in six key learning domains
  • TeachTown 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 study with
LAUSD During this 3-month study TeachTown
students had significant gains compared to
control groups
Web-based Curriculum Technology
  • Standardize the delivery of research-based
  • Provide training, collaboration supervision
    across multiple staff, families and geographic
  • Multi-media interactive formats
  • Supplements existing resources
  • Cost-effectively manage the increased demand
  • Proprietary CompaniesRethink Autism
    (www.rethinkautism.com)Center for Autism
    Related Disorders (www.centerforautism.com)

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Technology to Train Professionals
CARD eLearning 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 provide video
  • 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
  • Continuing education units available for this

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

Synchronization between multiple systems of care
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
    tasksApp manipulates text, numbers, or graphics
  • Classification of apps
  • Information worker (accounting programs)
  • Content access (web browser media player)
  • Entertainment (video games)
  • Educational (references learning software)
  • Enterprise infrastructure (database business
  • Simulation (flight driving emergency)
  • Media development (editing animation
    simulation 3-D)
  • Product engineering (design program testing
  • Over 140,000 apps for iPad (work, play,
    everything in between)
  • Google search autism app gt10,700,000 results

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

Autism Apps Websites
  • www.autismspeaks.org/family-services
  • www.autismepicenter.com
  • www.modelmekids.com
  • www.squidalicious.com
  • www.itunes.apple.com/us/app/autism
  • www.snapps4kids.com
  • www.hackingautism.org

Hacking Autism Website Idea
  • Examples of gt300 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

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

Academic Applications Class Scheduler Audio Books EBooks My Math Flash Cards Math Racer Campus Life Study Aid Study Buddy Home Work Tracker Writing Tips Complete Class Organizer
Vocational Applications Resume Generator Skype Interview Pro Career Builder Job Coach Monsterjobs Classifieds 2 go Career Jet Style Tips Ipad Mirror Dress to Impress Etiquette Pro Twitter BizzBites
Social Applications Facebook Fandango Skype Touch Trainer Fubar Twitter ooVoo Video chat Grocery Pal Bill Reminder Hours Tracker Ace Budget Dating DNA Dating Ideas Meal Planner Got Questions

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

Applying Futuristic Applications to the Diagnosis
Treatment of ASD
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
  • 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

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
  • can change the world.
  • Indeed, it is the only thing that ever has.
  • Margaret Mead
  • The only constant in life is change
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