Telehealth for Families of Children With Autism: Acceptability and Cost Comparison of Occupational Performance Coaching

BACKGROUND AND PURPOSE: The research questions were, How do parents rate and describe the acceptability of a 12-wk occupational performance coaching (OPC) intervention via telehealth? What is the cost comparison of a 12-wk OPC intervention via telehealth versus a home- or clinic-based model of service delivery? Telehealth provides a mechanism for intervention services to be delivered at a distance, and evidence of the effectiveness of occupational therapy delivered via telehealth is emerging (Cason, 2011). A study demonstrated that 87% more children could receive therapy services without increasing cost with telehealth (Cason, 2009). Our research team used OPC to provide a 12-wk intervention to families of children with autism spectrum disorder (ASD). OPC provides a means for a family-centered interaction style, and research indicates OPC’s ability to generate improved outcomes for parenting competence (Graham et al., 2013). However, it is unclear whether OPC is acceptable to parents when delivered via telehealth. Although telehealth aligns with the tenets of best practice in early intervention, cost comparison analyses for telehealth, in-home, and clinic-based services remain understudied (Vismara et al., 2013).

METHOD: This cross-sectional study drew from a larger pilot investigation using a within-sample pretest–posttest design. Our research team investigated the efficacy of a 12-wk telehealth OPC intervention for 18 families of children with ASD aged 6.9 yr and younger. We also completed acceptability and cost-effectiveness analyses for these 18 families. Parents completed a demographic questionnaire, including race or ethnicity, parent education, and socioeconomic status, and a 14-item Telehealth Acceptability Questionnaire (TAQ) after the intervention. The TAQ uses a Likert response scale (1 = strongly agree to 6 = strongly disagree) to measure parents’ ease and difficulty with using telehealth and their perceptions of the effectiveness of the content and process of the OPC intervention.

To examine the acceptability of the use of telehealth and the content of the intervention, we used descriptive statistics derived from the TAQ. To examine cost-effectiveness of the intervention, we calculated transportation costs (accounting for gas, car depreciation, and insurance) to the closest intervention providers of each family at $0.54 per mile, caregivers’ wages associated with driving time, and hourly rates of salaried early intervention occupational therapists at $28.85 per hour. We compared costs associated with the outpatient clinic model, in-home model, and telehealth model.

RESULTS: Specific items on the TAQ showed high mean parent responses. Parents found the OPC intervention content highly acceptable. The family burden was 1.18 times higher in the outpatient clinic model compared with the in-home model; family burden was 3.36 times higher in the outpatient clinic model compared with the telehealth model. Conversely, therapist burden was 2.20 times higher in the in-home model compared with the outpatient clinic model. Therapist burdens were equal in the outpatient clinic and telehealth models when considering individual sessions.

CONCLUSION: Findings suggest that parents of children with ASD rated telehealth highly acceptable, expressed comfort with the technology, and found the content of the OPC intervention model highly effective. The use of telehealth decreases cost burdens on both families and service delivery systems, thus potentially increasing access to services for children in rural and underserved areas. A telehealth service model provides one means to decrease barriers, including the resource and emotional toll, for families seen in an outpatient model and to minimize therapist demands seen with the in-home model.

IMPACT STATEMENT: Occupational therapy delivered via telehealth is an innovative service delivery model. Information from this study provides powerful knowledge regarding the acceptability and cost savings of telehealth. Our study indicates immense cost savings when using telehealth. Overall, telehealth provides an effective and innovative platform to reduce cost and increase access to services for families of children with ASD.

References

Cason, J. (2009). A pilot telerehabilitation program: Delivering early intervention services to rural families. International Journal of Telerehabilitation, 1(1), 29–38. https://doi.org/10.5195/ijt.2009.6007

Cason, J. (2011). Telerehabilitation: An adjunct service delivery model for early intervention services. International Journal of Telerehabilitation, 3(1), 19–30. https://doi.org/10.5195/ijt.2011.6071

Graham, F., Rodger, S., & Ziviani, J. (2013). Effectiveness of occupational performance coaching in improving children’s and mothers’ performance and mothers’ self-competence. American Journal of Occupational Therapy, 67, 10–18. https://doi.org/10.5014/ajot.2013.004648

Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43, 2953–2969. https://doi.org/10.1007/s10803-013-1841-8

Zylstra, S. E. (2013). Evidence for the use of telehealth in pediatric occupational therapy. Journal of Occupational Therapy, Schools, and Early Intervention, 6, 326–355. https://doi.org/10.1080/19411243.2013.860765