When the coronavirus forced much of the world into self-quarantine and social distancing this past spring, leaders at the Virginia Tech Autism Center had to rework how they operate.
In-person consultations, therapy, and diagnostic assessments were out. Not only that, but during the past two years, the Autism Clinic had been using a recreational vehicle that was converted to the Mobile Autism Clinic — nick-named MAC — to bring autism care and therapy to rural areas of Virginia. The MAC had to be parked. Angela Scarpa, director of the clinic, along with Jen Scott, the rural outreach coordinator for the clinic, and Scarpa’s graduate student clinicians quickly worked to move all services online.
“We knew it would be challenging to shift all of our services online, we also viewed this challenge as an opportunity to expand our reach with new research and service delivery,” said Scarpa, a professor of psychology, in June. “Imagine a world where all therapists are trained to conduct tele-therapy and tele-assessments for people with autism and their families, and where we overcome the usual barriers to providing such services. This was the moment to begin making this vision a reality.”
Working under HIPAA compliances and IRB approvals, Scarpa, Scott, and a team of graduate students brought this vision to life. “We know how essential these services are for families navigating so many challenges, especially in the wake of COVID-19,” Scott said. “Our desire when we launched the MAC was to also provide telehealth services. So, it seemed not only natural, but vital, that the Virginia Tech Autism Clinic, along with the Psychological Services Center and Child Study Center, shift our services online to maximize safety of everyone involved.”
Using Zoom, Scarpa and her team moved in-person therapy, diagnosis, and care to an online format. “As a research center, it was very important to us that we be able to use science to validate the telehealth instruments we were using in our diagnostic assessments,” Scarpa added. “Developing an assessment protocol that could be completed entirely remotely was a challenge because few, if any, such protocols exist in the research literature. So, we had to develop our own protocol based on instruments that were validated in-person but could be translated to remote observations.”
"With the shift to Telehealth services, we have been able to further support our ultimate goal, which is to reduce rural disparities we see in access to care for much needed evidence-based services by providing accessible, affordable options"
Among the challenges: counselors are disallowed from using home computers for therapy sessions. Instead, therapists must go to the clinic, located on Prices Fork Road, to carry out work, using Virginia Tech computers to record sessions. “This shift was tricky because there are no validated measures for strictly online diagnostic assessments,” Scarpa said. “To be true to our mission of merging science with service, we decided to conduct a research project to validate the use of a clinician’s online observation of the child in which activities are facilitated by a parent/caregiver who is present with the child. This research has now been added to a graduate student thesis project, which also continues our training mission.”
The clinic provides parents or caregivers with a script to use to engage with their child, using dialogue or activities. Clinicians, comprised of graduate students, watch and record the interactions of parent and child via laptop cameras. The recorded interactions are coded using previously validated scoring instruments that have been used in in-person observations. The clinicians also interview the parent or caregiver by Zoom or telephone in order to obtain a full developmental history and rule out other possible diagnoses. The offerings are growing, and have the advantage of expanding geographically to regions beyond rural South-western Virginia, where even the road-bound MAC could not reach.
“Clients who were on our in-person assessment waitlist prior to the pandemic have been able to shift to our online format, making it a mostly seamless process,” Scarpa said. The clinic also has been working with the Richmond, Virginia, based CA Human Services — a nonprofit dedicated to assisting families with children who are on the autism spectrum — to provide caregivers and professionals with educational webinars.
“With the shift to telehealth services, we have been able to further support our ultimate goal, which is to reduce rural disparities we see in access to care for much needed evidence-based services by providing accessible, affordable options,” Scott said. “It is of utmost importance that children receive a diagnosis as early as possible so they and their family can then access essential interventions and treatment over their lifetime. With continued funding support, we do plan to continue telehealth services post-pandemic and resume in-person services when it’s safe to do so.”
Newly developed telehealth services —borne out of necessity — will continue as part of the clinic’s daily operations. “With our new telehealth model, we hope to cast our net even wider and reach even more families,” Scarpa said in June. “The Mobile Autism Clinic will hit the road again in some capacity.”
With change, obstacles, and changing work cycles comes stress. Scarpa and Scott are no different to these effects.
“My husband and I have been trying to share the load of becoming a full-time teacher, secretary, tech support, and playmate for our 7-year old-while also working from home, which has had its challenges,” Scott said. “But I know so many of us are experiencing this and so much more on a daily basis.”
For Scarpa, who has an adult son on the spectrum, she added: “The initial transition to telehealth was very overwhelming on the front-end. I am now focused on developing and testing our new telehealth assessment model, which is very exciting to me. Person-ally, I appreciate spending time with my family, knowing they are all home safe and healthy.”