Telemedicine – connecting health care providers and patients via computer or smart phone for diagnosis and treatment — has been making it easier, and more cost-effective, to “see” the doctor. Using a camera-enabled computer or smart phone, patients with common health concerns can get some diagnoses without leaving their homes. Emergency room doctors and nurses are able to communicate with their peers in larger trauma centers via computer, as well.
Specific to Autism is the is the challenging situation to find experts in remote geographical areas including here in Binghamton, NY. This is one just one area of the country where it is more typical to see a lack of highly trained professionals to diagnose, consult, and prescribe psychotropic medications; and the outlook remains bleak. Technological advancements, such as telehealth, can offer an alternative to services provided in-person that may increase access of individuals with ASD to experts (e.g., behavior analysts) and at a fraction of the cost.
Even more difficult to find are the professionals who are certified in applied-behavioral analysis, or a CABA. This is a form of therapy that is covered by health insurance. For example, in NY State, Excellus Blue Cross/Blue Shield will cover this therapy at a co-pay of $25.00 to subscriber under the Platinum level of care. This same health insurer will also cover telemedicine for the same price. We know that in the managed care realm of providing services, the NY State agencies of Office of People with Developmental Disabilities and Office of Mental Health are already providing this service, of which it is paid for by Medicaid funds. Currently, one solution for families is to have a provider who is over 5 hours away fly in, see the patients all on one day, prescribe the medications and then leave. This option obviously leaves parents with no one to follow up with for medication adverse reactions that can sometimes happen on a new medication. Instead they have to bring their children, both young and adults to the local crisis center where, a person with autism quickly finds out that is not the appropriate service.
“Autism spectrum disorders, now estimated to affect one in 68 children, are just as common in rural America,” said Heitzman-Powell, research assistant professor of the University of Kansas, Life Span Institute “but ABA-trained professionals are rare.”
While involving parents in training is critical, according to the National Research Council, little is known about how to make training resources available to families in remote areas or with limited capacity to travel to facilities for one-on-one practice and coaching, said Heitzman-Powell, a licensed psychologist and a board-certified behavior analyst. Tele-medicine will provide that answer.
Now a new University of Iowa study, published recently in the journal Pediatrics, shows that parents with children on the autism spectrum are able to have a specialist address challenging behavior in these children by interacting over the computer, too — and at less than half of the cost of receiving similar care in person.
This means not just ABA as a therapy that can be provided through a television screen, but consults on behaviors and medical issues, particularly troubleshooting new medication regimens that are limiting the person and their family from enjoying more activities together. The parents or caregivers can follow-up more easily in these sessions.
“A lot of kids who are on the autism spectrum have significant problems with behavior,” says Scott Lindgren, PhD, professor of pediatrics in the Stead Family Department of Pediatrics at University of Iowa Carver College of Medicine, and lead author of the study. “These kids may have trouble following directions, or have problems when there are changes in their schedule or routine. They also don’t always have good enough communication skills to be able to explain to someone why they’re getting upset or having a meltdown.”
Already we are seeing providers of telemedicine set up businesses with one being The Autism Tele-medicine Company. They state that they founded the company because they “bring not only the medical expertise, but also the three dimensional experience with the disorder that comes from living with it at home. This combination renders us vastly more empathetic and sensitive to what you may experience all the way from the crushing time of autism diagnosis through your child’s adulthood.” However, again, they are a private health provider and it is still a provider’s choice as to whether or not they will accept public or private health insurance.
The major research centers in the country, particularly those under the National Institute of Health’s Research on Autism Centers of Excellence not only provide this service but continue to research its effectiveness. These centers are located at UCSF, Boston University, Emory, UCLA, UNC at Chapel Hill, University of Iowa, and Yale among others.