Transforming Hospitalizations of Autistic Adolescents via a Novel ABA Telehealth Platform

项目总结 有原发行为障碍的自闭症儿童住院治疗的趋势正在增加 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设备来满足最佳的行为护理 因此经历长期/延长住院的家庭，其行为可能不会 治疗不当，并有可能恶化。此外，无法充分应对 具有挑战性的行为可能会限制儿童被接受进入降级设施或回家的能力 安全，并有助于极有压力的护理方面。延长住院时间也会导致显著的 医院的财务回报为负(未报销/报销不足)。在之前的工作中，部署专门的简要 应用行为分析(ABA)评估和干预明确设计用于 住院治疗显示了挑战行为的改善，约束和人员配备的减少，以及 高水平的家庭满意度。不幸的是，社区获得这种类型的干预是极其困难的 受地理位置和提供商可用性的限制。适当的远程医疗和数字医疗系统 可以促进远程中介支持可能具有增加此类护理的可获得性的巨大潜力 儿童、家庭以及负责照顾他们的提供者和医院。虽然许多真正的技术- 时间视频会议可用(例如，缩放)，以便能够准确地支持对 前兆和关键行为背景技术能够支持智能监控、数据和 对关键行为进行标记，并在人力支持团队(专家和非 专家)需要在相当长的时间内(包括当专家不在场时)才能实现 有意义的远程媒体ABA服务。目前的项目创建并测试了一个潜在的临床价值 创新的远程医疗平台，促进适当、有效的ABA远程评估和干预 患有自闭症的青少年在住院和出院后过渡期间表现出挑战性的行为。 在这项工作的第一阶段，我们提出了与关键利益相关者共同设计新系统的建议和可行性 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， 我们磨练了系统的商业价值，并进行了严格的试验，以证明临床实用和财务 儿童、家庭、照顾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.