Haring Center

March 17, 2020

Virtual Parent Coaching Increases Access to Applied Behavior Analysis Services

“Imagine you’re a parent, and you receive a diagnosis that your child has an intellectual or developmental disability,” says Haring Center researcher and Behavior Analyst Katy Bateman (PhD ‘17). “But, due to a variety of factors, you are unable to access services and support.”

Applied Behavior Analysis (ABA) therapy, a component of early intervention for autism, aims to improve quality of life by focusing on changing human behavior in socially significant ways. With an autism diagnosis, families can access ABA services, but the number of providers in Washington falls far short of the actual need. Ultimately, families find themselves without services despite hearing the importance of these services early in their child’s development.

This need intensifies for children with other intellectual and developmental disabilities. Without an autism diagnosis, insurance providers are not mandated to cover ABA services. “We know from research that the strategies used in ABA are effective for a wide range of children diagnosed with different disabilities and disorders,” explains Bateman. “Families in Washington are currently unable to access meaningful services that will increase quality of life, and that is a huge issue. These families deserve better.”

According to Bateman, the earlier a child begins ABA therapy, the more substantial effects they experience. Through a new research grant, she is seeking to increase access to these services across Washington state.

Starting in May 2020, Bateman will lead a project funded by the Arc of Washington Trust Fund that uses an innovative online service delivery model to provide ABA coaching to parents of children with intellectual and developmental disabilities.

“There are so many barriers to accessing early intervention for children with disabilities,” says Bateman. “Service provider waitlists, transportation, childcare — the list goes on. Parents often serve as the case manager for their child, navigating a world of individual service providers. Our system is complicated, and families should not have to jump through so many hoops to access these beneficial services.”

“It is hard for me to think that we have effective interventions for children with intellectual and developmental disabilities, but not all families who would benefit can access them,” she continues. “So, I decided to find a way to provide these services online.”

Project ECHO (Extension of Community Healthcare Outcomes) is a case-based online service delivery model that builds expertise among participants. For this project, an expert panel will join parents of children with disabilities across 16 weeks to engage in collaborative problem solving and instruction on ABA principles.

“Project ECHO is based on the idea of ensuring the right knowledge is in the right place at the right time,” says Bateman. The model’s founder describes it as a “force multiplier,” as the problem solving and expertise applied to each case presented during an ECHO videoconference can apply to many other cases.

Initially launched in the medical field to increase patient access to healthcare, Project ECHO began connecting expert specialists with primary care clinicians. The model has since expanded: “Today ECHO models are successfully running across the world to serve populations affected by a disability or disorder,” says Bateman.

A defining feature of Project ECHO is the expert panel’s interdisciplinary nature. This project’s panel will consist of Bateman, Haring Center Director Ilene Schwartz and Haring Center Fellow Elizabeth Kelly as behavior analysts, a special education teacher and a parent of a child with Down syndrome.

“Project ECHO is case-based, so parents will present real-life situations they have found challenging at home, and the parents and panel will work together to provide interdisciplinary recommendations and suggestions,” says Bateman. “This design creates learning loops as we problem solve together.”

The intervention will begin in May, and the panel will spend 16 weeks working with the parents around principles of ABA. “We focus on parents, because they are the daily implementers,” explains Bateman. “Parents are key stakeholders in the success of the intervention.”

“Parents will learn basic principles of ABA so they can understand why behavior occurs, strategies to prevent challenging behaviors and how to respond to these behaviors when they do occur,” says Bateman.

Bateman says the desired project outcomes for parents include increased knowledge and implementation of ABA strategies, decreased challenging behaviors at home, and increased parenting confidence and competence.

The community aspect of the Project ECHO model is also central for Bateman.

“The goal of this project is to increase quality of life for families with children with disabilities, and part of that is providing parents with a community of support,” she says. “Through this intervention we are creating a community for parents of children with intellectual and developmental disabilities to know they are not alone.”

Parents of children with disabilities often experience high stress levels, and this project seeks to change that. “These parents are up against many of the same barriers,” says Bateman. “We want to foster relationships so after the 16 weeks, parents will be part of a social network of others and can navigate the future together.”

Bateman explains that families unable to access early intervention often report feelings of isolation. “I was asked recently why I want to carry out this project,” she says. “The answer is that I want families to know it is going to be OK, and that they have a group of people to support them.”