Telehealth and Autism: Treating Challenging Behavior at Lower Cost

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FIGURE 1
Average weekly FA and FCT treatment costs per child.

TABLE 1

Participant Characteristics for Children Who Received FA and FCT Treatment via Different Service Delivery Models

Variables	Group 1: In-Home Therapy, 1996–2009 (n = 44)	Group 2: Clinic Telehealth, 2009–2012 (n = 20)	Group 3: Home Telehealth, 2012–2014 (n = 30)	P
Age: mean (SD), mo	48.20 (15.44)	50.30 (15.53)	52.43 (17.45)	.491
Range, mo	22–83	29–80	21–84
Gender	13 F, 31 M	1 F, 19 M	5 F, 25 M	.060
Primary diagnosis, n (%)
ASD	13 (30%)^a	20 (100%)^b	30 (100%)^b	<.001^c
Other DD	31 (70%)	0 (0%)	0 (0%)
ID, n (%)	42 (95%)^a	10 (50%)^b	15 (50%)^b	<.001^c
Distance from Children’s Hospital
Mean (SD), miles	67.02 (40.33)^a	200.75 (95.25)^b	116.23 (77.85)^d	<.001^c
Range, miles	3–158	39–317	3–310
Social function identified, n (%)^e
Escape	36 (82%)	13 (65%)	17 (57%)	.056
Tangible	33 (75%)^a	16 (80%)^a ^b	29 (97%)^b	.035^c
Attention	19 (43%)^a	2 (10%)^b	3 (10%)^b	.001^c

F, female; M, male.
↵a When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵b When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵c Significant differences were based on ANOVA for continuous variables and χ² (or Fisher’s exact test for small cell sizes) for categorical variables.
↵d When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵e Children often had >1 social function.

TABLE 2

Behavioral Outcomes and Acceptance by Parents of FA and FCT Treatment via Different Service Delivery Models

Variables	Group 1: In-Home Therapy (n = 44)	Group 2: Clinic Telehealth (n = 20)	Group 3: Home Telehealth (n = 30)	P
Percentage reduction in problem behavior				.074
Mean (SD)	95.76% (8.91)	91.00% (13.66)	97.27% (6.00)
Range	59.07%–100%	47.40%–100%	77.01%–100%
Percentage increase in mands (appropriate requests)	N/A			.832
Mean (SD)	N/A	78.42% (25.53)	76.67% (27.48)
Range		20.5%–100%	13.3%–100%
Percentage increase in task completion	N/A			.301
Mean (SD)		51.53% (30.89)	61.15% (34.81)
Range		13%–100%	0.6%–100%
FA weekly visits
Mean (SD)	4.52 (1.57)	5.30 (1.49)	4.90 (1.92)	.219
Range	2–10	4–9	2–11	.219
FCT treatment weekly visits
Mean (SD)	17.05 (7.99)^a	9.05 (3.58)^b	9.10 (5.37)^b	<.001^c
Range	3–39	4–18	2–23	<.001^c
Acceptability ratings (Treatment Acceptability Rating Form–Revised; 1–7 scale)
Mean (SD)	6.55 (0.68)	6.53 (0.61)	6.25 (0.91)	.457
Range	5–7	5–7	4–7

ASD diagnosis was confounded with group, but a separate ANOVA based on only subjects with ASD produced similar results to the ANOVA based on the full sample.
↵a When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵b When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵c Significant differences were based on ANOVAs; main effects for group are presented because there were no significant group × ID interactions.

TABLE 3

Costs of Treatment With FA and FCT When Delivered via Different Service Models

Variables	Group 1: In-Home Therapy (n = 44)	Group 2: Clinic Telehealth (n = 20)	Group 3: Home Telehealth (n = 30)	P
Staff costs
Mean	$4687.86^a	$1693.30^b	$1190.00^b	<.001^c
(SD)	(1799.51)	(371.72)	(519.20)	<.001^c
Facility costs
Mean	$99.04^a	$172.20^b	$97.44^a	<.001^c
(SD)	(38.02)	(37.80)	(42.51)	<.001^c
Family costs
Mean	$1163.06^a	$1202.96^a	$858.20^b	.002^c
(SD)	(446.46)	(264.08)	(374.43)	.002^c
Total cost
Mean total cost per child to complete treatment	$5949.97^a	$3068.46^b	$2145.64^b	<.001^c
(SD)	(2283.99)	(673.60)	(936.15)

Sensitivity analyses based on 25%–50% higher or lower estimates of staff, facility, and family costs produced changes in total costs for each treatment, but the pattern of relative costs between groups remained similar.
↵a When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵b When there were significant between-group differences, groups with the same superscript in the same row did not differ from each other.
↵c Significant differences were based on ANOVA.