Pomales-Ramos Anamiguel, Tokish Hannah, Howard Mya, Straiton Diondra, Ingersoll Brooke
Michigan State Autism Lab, Psychology Department, College of Social Science, Michigan State University, East Lansing, MI, United States.
Front Psychol. 2023 Jul 20;14:1173644. doi: 10.3389/fpsyg.2023.1173644. eCollection 2023.
Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians ( = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services ( = 3.52, SD = 1.14) as more difficult than conducting assessments ( = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [( = 2.47, SD = 1.11), (2, 381) = 162.26, < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope ( = 4.37, SD = 0.81), children who exhibit challenging behaviors ( = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate ( = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.
在新冠疫情之后，临床医生依靠远程医疗来确保基本医疗服务的连续性，比如应用行为分析（ABA）。识别障碍并在其他实施成果的背景下对其进行审视，对于支持远程医疗提供的ABA服务进行适当调整和可持续发展至关重要。采用了收敛性混合方法设计，以识别在新冠疫情头六个月后，ABA临床医生（n = 388）向自闭症儿童及其家庭提供远程医疗ABA服务时所遇到的障碍。此外，还研究了与远程医疗实施成果及持续采用意愿相关的障碍。研究结果显示，临床医生认为提供直接服务（M = 3.52，标准差 = 1.14）比进行评估（M = 3.29，标准差 = 1.06）更困难，且两者都比提供家长介导干预更困难[（M = 2.47，标准差 = 1.11），F(2, 381) = 162.26，p < 0.001]。主成分分析表明障碍可分为三个因素：（1）技术（α = 0.82），（2）行政任务（α = 0.88），以及（3）客户特征（α = 0.88）。最常被认可的障碍与客户特征有关，包括向逃跑的儿童（M = 4.37，标准差 = 0.81）、表现出挑战性行为的儿童（M = 4.31；标准差 = 0.83）以及处于语言前阶段或使用非语言进行交流的儿童（M = 4.07；标准差 = 1.00）提供远程医疗服务的难度增加。与客户特征相关的较少障碍独特地预测了实施变量，包括可接受性、适宜性和可行性。主题分析揭示了与技术、照顾者参与、儿童参与、通过远程医疗实施干预策略以及行政或后勤障碍相关的挑战。这些研究结果凸显了需要有针对性的策略来促进远程医疗的使用，以满足特定客户需求，并支持在常规护理环境中实施远程医疗服务。
