Transforming Hospitalizations of Autistic Adolescents via a Novel ABA Telehealth Platform

项目摘要 患有ASD的儿童有越来越多的主要行为挑战住院治疗， 医疗设施，因为当地社区没有可获得的行为支持资源。 不幸的是，大多数以社区为基础的医院没有很好的装备，以满足最佳的行为护理， 因此经历长期/长期住院的家庭，其中行为可能不 得到充分治疗，并可能恶化。此外，具体无法充分应对 挑战性行为可能会限制儿童进入降级设施或返回家园的能力 安全，并有助于护理的极端紧张方面。长期住院也会导致显著的 医院的财务回报为负数（未偿还/偿还不足）。在以前的工作中，部署专门的简报 应用行为分析（阿坝）评估和干预明确设计用于 住院表现出挑战行为的改善，限制和人员配备的减少， 家庭满意度高。不幸的是，社区获得这种干预的机会极其有限。 受地理位置和供应商可用性的限制。适当的远程保健和数字保健系统， 可以促进远程介导的支持可能有很大的潜力，增加这种照顾的可用性， 儿童、家庭以及负责照顾他们的提供者和医院。虽然许多技术用于真实的- 时间视频会议可用（例如缩放），以便能够准确地支持理解 能够支持智能监控的关键行为技术的前兆和背景，数据- 标记，并在人力支持团队（专家和非专家）之间有效地沟通关键行为 专家）在很长一段时间内（包括专家不在场时）需要启用 有意义的远程阿坝服务。目前的项目创造和测试的潜在临床价值， 创新远程保健平台，以促进适当，有效的阿坝远程评估和干预， ASD青少年在住院期间和出院后过渡期间表现出挑战性行为。 在这项工作的第一阶段，我们提出了与关键利益相关者和可行性共同设计的新系统 测试，以证明技术能力和潜在的临床价值。在这项工作的第二阶段， 我们磨练系统的商业价值，并进行严格的试验，以证明临床实用性和财务 儿童、家庭、护理系统和付款人的回报。

PROJECT SUMMARY There is an increasing trend for children with ASD with primary behavioral challenges to be hospitalized in medical facilities because accessible behavioral support resources are not available in local communities. Unfortunately, most community-based hospitals are not well equipped to meet optimal behavioral care with families consequently experiencing prolonged/protracted hospitalizations where behaviors may not be adequately treated and could potentially worsen. Further, the specific inability to adequately respond to challenging behaviors may limit the ability of children to be accepted into step-down facilities or return home safely and contribute to extremely stressful aspects of care. Prolonged hospitalizations also result in significant negative financial return for hospitals (un/under-reimbursement). In prior work, deploying a specialized brief Applied Behavioral Analysis (ABA) assessment and intervention explicitly designed for use during hospitalizations demonstrated improvements in challenging behaviors, decreases in restraint and staffing, and high levels of family satisfaction. Unfortunately, community access to this type of intervention is extremely limited by geographic location and provider availability. Appropriate telehealth and digital health systems that can facilitate tele-mediated support may hold great potential for increasing the availability of such care to children, families, and the providers and hospitals responsible for their care. While many technologies for real- time video conferencing are available (e.g. zoom), in order to be able to accurately support understanding of precursors and the context of key behaviors technologies capable of supporting intelligent surveillance, data- flagging, and efficient communication of key behaviors across human support teams (both expert and non- expert) over substantial periods of time (including when experts are not present) are needed to enable meaningful telemediated ABA service. The current project creates and tests the potential clinical value of an innovative telehealth platform to facilitate appropriate, efficacious ABA tele-assessment and intervention for adolescents with ASD displaying challenging behaviors during hospitalizations and post-discharge transition. In the first phase of this work, we propose co-design of the novel system with key stakeholders and feasibility testing to demonstrate both technical capacity and potential clinical value. In the second phase of this work, we hone the systems commercial value and conduct a rigorous trial to demonstrate clinical utility and financial return for children, families, systems of care, and payers.