Overview of Telehealth

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Overview of Telehealth Technology for
Individuals with ASD and Their Families

• Dr. Lou Vismara
• Consultant, Sen. Darrell Steinberg
  louis.vismara_at_sen.ca.gov
• Ph [phone]
• Fx [phone]

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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
  platforms
• Integration of technology with other programs
  services
• Information evaluation outcomes assessment

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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

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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

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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

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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
  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

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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
  communication

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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

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U.C. Davis Center for Health Technologywww.ucdmc
.ucdavis.edu/cht/Enhancing Mental health
Services for Children with ASD in Rural
Communitieswww.media.americantelemed.org/conf/20
08/Presentations

• Overview of Telehealth
• Tertiary care center target communities
• Practical considerations for implementation of
  services
• 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

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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

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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
  Therapy

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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

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The MIND Institute ESDMQuality of Participation
Outcomes Involves
Quality of parent-child sharing
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Parents Click on Selected Topic
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The MIND Institute Virtual Reality LabDr. Peter
Mundy

• PRELIMINARY RESULTS
• Joint attentionlearning
• Joint attention improves gtage
• Joint attention delayed with HFA
• Joint attention/HFA improved post virtual training

• PRELIMINARY STUDY
• 3-D simulated classroom
• Nine avatar peers
• Multitasking activities
• Controlled interventions

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The U. C. Davis MIND Institutewww.ucdmc.ucdavis.e
du/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 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 

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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
  communication
• Communities of practice
• Resource information center
• New therapeutic modalities

• Process of adopting technology
• Knowledge
• Persuasion
•  Decisions
• Implementation 
• Confirmation

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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

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Autism Learning Platform
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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

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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
  generalization
• 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

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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
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Web-based Curriculum Technology

• Standardize the delivery of research-based
  services
• Provide training, collaboration supervision
  across multiple staff, families and geographic
  locations
• 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
  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

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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

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Synchronization between multiple systems of care
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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
  workflow)
• Simulation (flight driving emergency)
• Media development (editing animation
  simulation 3-D)
• Product engineering (design program testing
  editing)
• Over 140,000 apps for iPad (work, play,
  everything in between)
• Google search autism app gt10,700,000 results

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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

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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

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Hacking Autism Website Idea
Gallerywww.hackingautism.org

• 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
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Applications
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
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Integration Implementation
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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

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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

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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

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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