Delivering allied health services to regional and remote participants on the autism spectrum via video-conferencing technology: lessons learned

Context: The introduction of individualised funding under the NDIS in Australia aimed to increase individual choice and control over how people received disability supports. An increase in the allied health disability workforce was anticipated however, disability workforce sector reports have consistently indicated difficulties in attracting and retaining sufficient allied health staff to satisfy current and future demand. Autism Spectrum Disorder is the most prevalent primary diagnosis of participants receiving individualised funding to date and requires support staff to have specialised skills and experience. Given that overall staff attraction and retention issues are reported to be exacerbated in regional and remote areas of Australia, it is important to seek innovative ways of supporting individuals on the autism spectrum in their local community. Technology has the potential to provide a timely and low-cost alternative that extends access to specialist services for people in remote locations.

Aims of the evaluation: The current project aimed to identify the feasibility, essential requirements and potential barriers in delivering therapy support to regional and remote participants on the autism spectrum via video-conferencing technology.

Procedure: A multi-disciplinary team (speech pathologist, occupational therapist, psychologist and a special educator) were recruited and trained to deliver tele-therapy services to 16 participants on the autism spectrum, in collaboration with their families and local support teams. Participants resided in two northern, nine western and one southern regional area in New South Wales, Australia. There were three sets of siblings. One participant resided on remote Lord Howe Island off the coast of Northern New South Wales. Researchers used semi-structured telephone interviews to gain insight into the program from key stakeholder groups including parents, education staff, allied health professionals, and tele-therapists. A general inductive approach to data analysis was used under five project evaluation areas.

Lessons learned: The evaluation focused on five areas including 1) the development of the tele-health delivery team, 2) understanding the role of collaboration, 3) examining the need for autism-specific support, 4) establishing the need for in-person contact, 5) and identifying barriers to success. The project evaluation found that investment in staff training and support was key to building a competent tele-therapy team and delivering successful tele-therapy services under a sustainable model. For many families and support team members, collaboration was reported as an important part of the tele-therapy program, with families and teachers finding it helpful to work together with the same information. The evaluation confirmed that access to autism-specific knowledge and support was novel and regarded as beneficial for families and support teams living in regional and remote areas. There were mixed responses to the inclusion of in-person support as part of a tele-therapy service. While some families felt a tele-therapy service was no different to in-person services, other families and tele-therapists indicated that the addition of at least one in-person session would help to increase rapport. Barriers within the tele-therapy model included scheduling and local staff changes, as well as the delivery of intervention requiring physical support. Technology was not seen as a barrier in the current study.

Conclusions: This research adds to the growing body of information supporting the use of tele-practice for geographically isolated regions. Ideally, tele-therapy should not replace in-person services however it is necessary when no other comparable service option is available locally. Larger scale research is needed to compare blended, online and in-person models so that an optimal ratio can be established.