Delivering allied health services to regional and remote participants on the autism spectrum via video-conferencing technology: lessons learned.
Delivering allied health services to regional and remote participants on the autism spectrum via video-conferencing technology: lessons learned.
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DOI：
10.22605/rrh5358
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发表时间：
2019-09-01
影响因子：
2.1
通讯作者：
Crook, Sarah
中科院分区：
文献类型：
--
作者：
Johnsson, Genevieve;Kerslake, Rachel;Crook, Sarah
背景和问题：澳大利亚在国家残疾保险计划下实行个性化供资，目的是增加个人选择和控制人们如何获得残疾支助。预计残疾专职保健工作人员将增加；然而，残疾人劳动力部门的报告一直表明，难以吸引和留住足够的专职保健人员，以满足当前和未来的需求。自闭症谱系障碍是迄今为止接受个性化资助的参与者最普遍的初级诊断，需要支持人员具有专业技能和经验。考虑到据报道，在澳大利亚的区域和偏远地区，总体的员工吸引和留住问题加剧了，寻求创新的方式来支持当地社区的自闭症患者是很重要的。技术有可能提供一种及时和低成本的替代方案，使偏远地区的人们能够获得专业服务。目前的项目旨在确定通过视频会议技术向区域和远程自闭症患者提供治疗支持的可行性、基本要求和潜在障碍。经验教训：招募并培训了一个多学科小组（语言病理学家、职业治疗师、心理学家和一名特殊教育工作者），与他们的家人和当地支助小组合作，为16名自闭症谱系参与者提供远程治疗服务。参与者居住在澳大利亚新南威尔士州的两个北部地区、九个西部地区和一个南部地区。有三对兄弟姐妹。其中一名参与者居住在新南威尔士州北部海岸外遥远的豪勋爵岛。研究人员使用半结构化的电话访谈，从包括家长、教育人员、联合卫生专业人员和远程治疗师在内的关键利益相关者群体中深入了解该计划。在五个项目评价领域采用了一般归纳方法进行数据分析。评价侧重于五个领域，包括：发展远程保健服务团队、了解协作的作用、审查针对自闭症的支助的必要性、确定面对面接触的必要性以及确定成功的障碍。项目评价发现，对工作人员培训和支助的投资是建立一支称职的远程治疗团队和在可持续模式下成功提供远程治疗服务的关键。据报道，对于许多家庭和支持团队成员来说，协作是远程治疗项目的重要组成部分，家庭和教师发现在相同的信息下一起工作很有帮助。评估证实，获得自闭症相关知识和支持的途径是新颖的，被认为对生活在地区和偏远地区的家庭和支持团队有益。对于将面对面的支持作为远程治疗服务的一部分，人们的反应不一。虽然有些家庭认为远程治疗服务与面对面的服务没有什么不同，但其他家庭和远程治疗师表示，至少增加一次面对面的会议将有助于增进融洽关系。远程治疗模式存在的障碍包括日程安排和当地工作人员的变动，以及提供需要物理支持的干预措施。在目前的研究中，技术并未被视为障碍。这项研究增加了越来越多的信息，支持在地理上孤立的地区使用远程医疗。理想情况下，远程治疗不应该取代面对面的服务；但是，当本地没有其他可比较的服务选项时，这是必要的。需要更大规模的研究来比较混合、在线和面对面的模型，以便建立一个最佳的比例。
Context and issues: The introduction of individualised funding under the National Disability Insurance Scheme 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 communities. Technology has the potential to provide a timely and low-cost alternative that extends access to specialist services for people in remote locations. 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. Lessons learned: A multidisciplinary 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 (NSW), Australia. There were three sets of siblings. One participant resided on remote Lord Howe Island off the coast of northern NSW. 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. The evaluation focused on five areas including: development of the tele-health delivery team, understanding the role of collaboration, examining the need for autism-specific support, establishing the need for in-person contact 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. 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.