It is an exciting time to be working in the field of autism. The amount of research being conducted on autism diagnosis and treatments now cuts across many disciplines and specialized fields. At major conferences, it is not unusual to hear about breakthroughs from geneticists, psychologists, behaviorists, neurologists and a host of other disciplines. The challenge we face is enormous, but the brainpower that is marshalled on our side is growing exponentially. I can see clear signs of optimism in the collective progress we are making.
What is even more exciting to me is that the insights of researchers in (apparently) unrelated fields is beginning to give insight to the work of others. In my research on the comparative efficacy of different video modeling techniques, for example, I have consulted with neurologists, linguists, audiologists, psychologists, speech pathologists, educators and even parents. Each has added critical insight to my work because each possesses a unique lens through which to help me analyze and process my findings.
I feel fortunate to have the multi-faceted background I do—it gives me a powerful impetus toward collaboration, and a perch from which to see what the future of care may look like. Fifteen years ago, I began working as a clinician in several cutting-edge therapy programs in private pay homes. Within a year I was supervising those programs and coordinating teams of specialists. From there, I went on to obtain my doctorate in special education and was able to work directly as an educator in special education classrooms, while also teaching at a university. I followed that with over a decade in a large clinical setting, advising parents and overseeing school district programs where speech therapists, occupational therapists, BCBAs and teachers all worked together.
I have seen the view from the research bench, from a clinician’s viewpoint, from the teacher’s desk, through a school administrator’s eyes and from within a family’s home that has been affected by an autism diagnosis.
If we are to look at the future of autism care, it is a future that harnesses the unique contributions and perspectives each one of those players brings to a child’s life. Just as in the research world, no one discipline has the answer.
Luckily, we live in a world that is increasingly interconnected through technology. As I bring my practice into the future, I have embraced many of the new and powerful tools that are available online and I have seen how much easier collaboration becomes.
I’d like to discuss what I see as the most promising trends in autism care: 1) the increasing willingness of specialists to collaborate and 2) the power technology can bring to our practices. I will discuss these by giving practical examples.
Collaboration and Flexibility Are the Keys to Success
While I conducted studies in grad school my advisors always told me to stay away from “treatment packages” as we would never know what specific part of the treatment package was working (unless of course we could set appropriate controls). In a perfect world, that would be true. And, as BCBAs we should strive to bring the rigor of the scientific approach to everything we do.
But we don’t live in a perfect world. We live in a world where budgets are strained, where (in many rural areas) clinical expertise is simply not available, where challenging home environments may have students who have difficulty transitioning into a classroom. As a teacher, I saw this every day. In some cases, I may not have had full control of the process. Often, there were so many interventions happening at once, I was not at all equipped at the time to use my savvy ABA skills that had worked so well in university settings. There were many variables to evaluate and different clinicians or team members tied to specific pieces of an individual student’s program. It was not possible to isolate treatments. I had to work with my colleagues and do the best with the data we had, and combine our skills to find consensus (or something close to it) so we could move forward.
I have worked in many settings. I have worked in settings where speech therapists and BCBAs saw each other as rivals. I have worked in settings where parents viewed administrators as enemies that would be threatened or sued. I have also worked in environments where a spirit of flexibility and teamwork were present. These collaborative environments always resulted in bigger gains and observably happier children.
Technology is the Key to Collaboration and Better Results
I don’t think anyone doubts that technology will play a growing role in treatment as we learn to harness our clients’ natural attraction to screen-based technology. But we should not overlook the power of technology to dramatically improve the ease and efficiency of providing treatment to children nor its use as a collaborative tool.
Every teacher and clinician will find their preferred technological tools. But in my practice, there are three specific ways I use technology.
Collaboration with tele-therapy – I work in the Pacific Northwest. In many rural areas, there are literally no specialists available to parents. I also get calls from parents in other countries who cannot find well-trained therapists in their home countries. I have found tele-therapy to be the most effective way to address these issues. It is an efficient, cost-effective way to share information and “observe” individuals more often than only with in-vivo sessions. Tele-therapy addresses the access issues many families contend with today, especially with the rising number of diagnoses and the lack of access in many regions to high quality therapy or to any therapy services at all.
Tele-therapy allows me to check data real-time, see skill acquisition through video clips and Skype sessions, and communicate with all team members essentially at one time. Again, this does not at all replace in-vivo therapy, it just enhances that time between the individual with exceptionalities and his or her therapist.
Tele-therapy is not as hard as it sounds. I use a combination of several online products: Skype (a video conferencing tool), Dropbox (a file sharing tool), and GemIIni (an online library of video modeling tools). It may sound complicated, but the power of tools such as those three used together have benefitted all of my clients, regardless of their access to services in the area. With these types of technological tools, we can overcome the geographic barriers to care so many families currently face.
To start, I conduct a full video-conference with the parents to get a full picture of the current therapy program, the home environment and the child’s current skill set. I then spend time speaking with the child (when possible) to get a clinical determination of the issues we will be addressing. I speak with whatever other educators or specialists are working with the child. I also include a heavy dosage of parent education. Finally, I ask the parents to video the child in various situations and share those files via Dropbox.
Once I have determined the best course of action, I use technology to provide a blend of interventions and often work directly with the child or watch her doing various activities with her parents. In the past, I have often wished I could be a “fly on the wall,” and with Skype I can be just that—the child often forgets that I am there. I get to observe much more natural interactions than I have been privileged to see in the past.
Finally, after a tele-therapy session, for many of my clients I go online to create a customized video modeling homework session for the child from GemIIni’s online library of videos. This provides hours of clinically appropriate therapy for the parents and is a great primer for my next session.
Collaboration of community through technology – While working so heavily with online tools, I have come to see how technology has become such a powerful tool for collaboration and data collection. Everyone who works with one of my tele-therapy clients knows, for example, that she learned the word “cat” through GemIIni’s videos. This is crucial for generalization. We want to make sure that the client not only says “cat” when she sees the picture of a cat on the computer screen, but that she says “cat” when she sees a real cat in her environment. When we all use the same tool – parents, babysitters, teachers, therapists – we are all on the same page and we all provide multiple learning opportunities throughout the day for her to work on her new skills.
If we are to continue to strive for success in the future, it will be by working as a team and becoming as efficient as possible in the way we use our time and resources. The key to doing that will be collaboration and the effective use of technology. The more I embrace each, the better results I see. In that spirit, I am happy to share my experiences with any of you who have questions, and I am eager to hear what new technologies have helped you provide more focused and efficient care for your clients. You can reach me at firstname.lastname@example.org.