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Lauren M. Little, PhD, OTR/L
Anna Wallisch, PhD, OTR/L
Advancing Innovative Service Delivery in Occupational Therapy:
Evidence-based Practice Through Telehealth
Telehealth service delivery is in our future as
occupational therapists. Due to the relative novelty
of occupational therapy (OT) services delivered via
telehealth, we need evidence to help us understand
what practices may be effective when delivered using
information and communication technologies, such
as videoconferencing. My purpose here is to describe a
project in which we are testing the effects of a hybrid
telehealth coaching/online educational model that
targets adaptive behaviors among young children with
autism spectrum disorders (ASD), which was funded
by an intervention research grant from the American
Occupational Therapy Foundation (AOTF).
Our research team has been providing telehealth
OT sessions to families of young children with autism
spectrum disorders (ASD) for a few years. We first
started providing telehealth intervention after receiving
a previous AOTF intervention research grant, led by Dr.
Winnie Dunn, to test a coaching model to address any
occupational performance challenges using telehealth.
That study (Little, Pope, Wallisch, & Dunn, 2018),
showed positive results and our team kept talking about
how to enhance the process for families. Families chose
their own goals for the intervention and we noticed
that they often wanted to work on similar child skills,
including toilet training or mealtime behavior. Using a
coaching model, we found ourselves often asking families
about what they knew about those topics or where
they could find evidence-based resources. After many
discussions with our research team, we thought ‘What
if we provided a family-friendly, fun, and engaging way
to provide information to families about topics that
they seem most interested in?’. We have all worked with
clients or families that do not have the time to read the
book, to read the article that we send them, or that seem
to be ‘uncompliant’ with the home program. What if we
tried to make those resources accessible to families in a
different way?
We created TeleSCOPE (Telehealth Strategies for
Collaborative Occupational Performance Engagement),
which is a parent training intervention that combines
self-directed online educational podcasts and resources
with individualized coaching sessions to increase
child adaptive behavior. We offer parents five live,
videoconferencing sessions over 10 weeks as well as access
to all podcasts and online resources. We are currently
focused on toilet training and mealtime behavior, and
have podcasts available for these topics.
Podcasts are gaining popularity and are an accessible
and easy resource to integrate into daily routines. In a
recent survey study, Neilson (2018) found that 44% of
Americans have listened to a podcast (124 million people)
and 26% of Americans listen to podcasts weekly (that’s
73 million people!). As OTs, what if we packaged some
of our educational information for clients and families
into a podcast format? That is what our research team is
trying to do: make information and strategies about how
to increase children’s participation in everyday activities
(e.g., mealtime, toilet training) into fun and engaging
10-30 minute episodes. We have clear takeaway messages
for each episode, and parents listen to podcasts about the
specific skills in which they believe need to be enhanced
to promote child skills. For examples, in the toilet
training podcasts, we have episodes focused on dressing,
sensory processing, and wiping. Parents listen to podcasts
and we then provide videoconferencing support for the
strategies that they choose to try with their children after
listening to the podcasts.
Parent response to the program has been overwhelming
and positive. When we started this project, I understood
that there is a paucity of research about toilet training
interventions for young children with ASD, but I did not
fully understand the effect of toilet training on families’
lives. Families struggle to access help with this skill for
their children, particularly children that may no longer
receive home-based OT services. Toilet training opens
doors for children, allowing them to access educational
and social opportunities that are not available to those
in diapers. For children with special needs, including
ASD, toilet training may look quite different from
typically developing children. Many parents have told us
that the classic 3-day, naked toilet training method just
did not work for their child with ASD. As occupational
therapists, we can help parents gain the skills to employ
task analysis to understand the sensory, motor, and
environmental features of the routine. Parents can then