Helping At-risk Families in Rural Idaho, Eastern Washington

NODA-Child-iphone-header4The University of Idaho Child & Youth Study Center has been collaborating with other autism health professionals on Behavior Imaging’s National Institute of Health (NIH) research grant to explore alternative methods of diagnosing autism spectrum disorder earlier, especially for children in underserved and rural areas.

U of I diagnostic clinicThe Center will still accept participants into this program from outlying areas (remote to Moscow) who may be suspect of having autism until May 31st, 2016. Participants must be between the ages of 1 and 7. If you can share this opportunity with your network especially in surrounding rural communities who would like further information and potentially participate in this research initiative, they can contact Dr. Gwen Mitchell at gmitchell@uidaho.edu , 208-885-6191

As part of this study, the University’s clinic will provide comprehensive diagnostic assessment to
participants at no charge if they choose to complete the two stages of this process.
1) a comprehensive evaluation at the University clinic in Moscow and
2) complete the Naturalistic Observation Diagnostic Assessment protocol from their homes (which will be discussed in depth when interested families contact the clinic). Nominal financial compensation is given to the family after they complete each phase.

This will be an excellent opportunity for parents of children who have no or limited insurance coverage or who are on Washington Medicaid. Please contact Gwen Mitchell if you would like to discuss NODA and this study. We are excited to work with the NIH and our other partners nationwide in developing a tool that may revolutionize the way we make diagnostic determinations.

SARRC logo

Sincerely,
Ron Oberleitner, Principal Investigator – NIH Study – ‘Accelerating the diagnosis of autism spectrum disorder in rural Idaho via evidence-based Smartphone technology’ –

About The NIH SBIR Grant

Small Business Innovation Research (SBIR) – Grants for Brain and Behavior Tools

Download the Document

The National Institutes of Health (NIH) Blueprint for Neuroscience Research is a collaborative effort among the NIH Office of the Director and 15 institutes and centers to accelerate the pace of discovery and understanding in neuroscience research.

This Funding Opportunity Announcement (FOA) is affiliated with the Neuroscience Blueprint, with institutes and centers participating independently, and with participation by institutes that are not part of the Neuroscience Blueprint.

Until now, Phase II competing renewal SBIR grants have been encouraged for technologies that would ultimately require federal regulatory approval (e.g., drug development). There are, however, important technologies that would not be subject to such regulation, but that still require extraordinary time and effort to develop. The purpose of this FOA is to encourage applications for competing renewals of existing Phase II grants which are supporting research and development of such technologies. The competing renewal award would provide up to an additional three years of support at total cost funding levels of up to $800,000 per year.

Technologies encouraged by this FOA fall into three broad categories, which are described, below:

1. Complex instrumentation

This is instrumentation comprising several distinct parts that must work together. Very often the goal of such projects is to deliver turnkey products for researchers. For example, high density electroencephalography instrumentation includes electrode arrays, amplifiers, data analytic and data visualization software, etc. Another example is non-invasive near infrared imaging instrumentation, which might include photon sources and detectors, and timing devices for delivering photons, amplifiers, and software. Some high throughput assay systems may fall into this category.

2. Clinical Research Tools

Such tools would include those that are developed for clinical research use that do not require any federal regulatory approval, but still require extensive development in order to demonstrate validity in a diverse population. For example, computerized patient assessment tools for mental health disorders that are sensitive to developmental change, gender and cultural diversity, variation in cognitive and behavioral functioning, hearing and/or speech impairment, and co-morbidity with other disorders.

These tools may include data from blood work, medical history, biobehavioral information, and functional capacity, with the biobehavioral/functional information collected through clinician to patient surveys, clinician to caregiver surveys, patient self-assessment surveys, or a combination of surveys.

3. Behavioral interventions/treatments

Evidence-based behavioral interventions can play a role in the treatment of behavioral disorders. Novel therapies and novel means of providing these types of therapies (e.g., web-based tools) require not only their development, and small efficacy studies, but also extensive, large scale testing to determine the treatments’ true effectiveness across diverse patient populations.

Current Innovations

4888532947_535c5482aaThe ability to start autism screening and diagnosis the same day – which saves an average of 6 to 9 months in earlier diagnosis and earlier intervention – sets the child miles ahead in development. Telehealth holds this same promise for a huge array of health and behavior issues where time is of the essence.

It’s innovations like that which has won grants and the support of our sponsors.

Here are more features of our current technology that our sponsors and supporters value:

Visual Evidence – “Visual Behavior Specimens” – are a Game-changer

  • Video makes for rich, quality, informative data
  • Multiple reviews/assessments of one set of evidence – Multiple examiners
  • These factors lead to evidence-based practice and less subjective research, diagnosis, and care
  • Unlike observation, video can be stored, archived, and can be revisited later
  • This builds a research subject pool for scientists
  • We’re creating a registry of data, the world’s largest video pool of “Visual Behavior Specimens”

NODA- Naturalistic Observation Diagnostic Assessment

  • Quality of data capture based in natural environments using NODA for direct observation
  • Application to wide array of health and behavior applications from nursing transfer training to PTSD and Alzheimer’s intervention, to medication management

Technology Lowers Connection Barriers

  • Accessible and Portable to overcome 5 barriers – Time, Geography, Professional expertise, Cost, Communication
  • Flexibility among Dx systems; Ease of transfer for Dx results
  • Quickly switch between DSM4 and DSM5 – debates may rage on but the video data never change
  • Access to specialists improves quality and speed of diagnosis and care

 

Problems We’re Tackling

The Critical Need For Telehealth Research

5-31-2013-7-49-56-PM-150x150There is a pressing need for diagnostic and intervention services to support the rapidly growing population of children with Autism Spectrum Disorders (Autism and Developmental Disabilities Monitoring (ADDM) Network, 2009). Direct observation of the child remains the gold standard practice in diagnosis, assessment, and treatment planning for children with autism and related developmental disabilities (Filipek, Accardo, Barnek, Cook, Dawson, Gordon, et al.,1999; National Research Council, 2001; Ozonoff, Goodlin-Jones & Solomon, 2005). Moreover, the literature supports early screening to ensure that children are referred for diagnostic assessments sooner, and that timely evaluations of eligibility for services result in immediate implementation of appropriate early intervention (American Academy of Pediatrics Council on Children With Disabilities, 2007; Johnson, Myers).

Despite this literature, many rural communities that are also characterized by low socio-economic status (SES) are marked by lack of access to autism-specific expertise among professionals in mental health, primary care, and education (Belfer & Saxena, 2006; Marcin, Ellis, Mawis, et al., 2004; Nesbitt, Rogers, Rich, et al., 2006). Even in urban communities where services are more widely available, timely access to diagnostic and intervention services is often hampered by long waiting lists at centers focused on diagnosis and treatment (Hayden, 2011).

Telehealth Practices Promising and in Need of More Research

Despite gvlcsnap-2013-02-18-18h44m59s235-e1379549601825-150x150rowing recognition of the potential for telehealth to improve access to care for individuals with ASDs (Karp, Grigsby, McSwiggan-Hardin, Pursley-Crotteau, Adams, Bell, W., et al., 2000; Saint-André, Zalentein, Robin, & Lazartigues, 2011; Terry, 2009; Baharav & Reiser, 2010), few peer-reviewed evaluations of telehealth technologies applied to autism have been published (Boisvert, Lang, Andrianopoulus & Boscardin, 2010). Boisvert and colleagues (2010) found that 7 of the 8 studies reviewed reported successful implementation and positive outcomes of services delivered via telepractice. However, the total number of participants across these studies was extremely small (n=46), most lacked a true experimental design, and only a single study directly compared the effectiveness of services delivered via telepractice to the same services delivered in person.

The authors concluded that telepractice is a promising service delivery approach for individuals with ASD that warrants additional research, particularly with respect to technological requirements to support diagnostic protocols and intervention procedures, analysis of clinical efficacy and effectiveness, and cost-benefit analyses. Based on these identified areas of need, our system for approaching both diagnostic assessment and treatment planning will address these shortcomings and the effectiveness and efficacy of the system will be tested in two separate clinical settings using rigorous scientific methods.

Shortening Wait Lists, Providing Care to Remote Areas

vlcsnap-2013-04-23-12h17m29s122-150x150Asynchronous (store-and-forward) telehealth technology, such as our own Behavior Imaging technology, demonstrates how contextual video capture and a complementary online consultation platform effectively address the need for observation of the child by a professional who can make more timely clinical decisions regarding diagnosis and treatment. Beyond the potential for such technology to improve access to care for remotely located children (i.e., rural areas, military bases, etc.), it can also enable clinical centers around the country to shorten their wait-lists by facilitating more timely communication with families about the nature and range of the child’s symptoms and needs. There is great potential for enabling these centers to quickly gather initial clinical impressions of the child by reviewing videos collected by caregivers in the home, and then to more effectively triage cases into those that are clear cut and those that require more extensive in-person assessment.

In addition, the system allows for multiple raters to view evidence thus providing a format for documenting inter-rater reliability. In cases where raters are not in full agreement as to a specific diagnosis or plan for treatment, this system also allows for a third rater to view the evidence and weigh in on the decision. This capability further allows clinicians and educational professionals to make more informed decisions based on visual evidence.

Capturing Behavior in a Natural Setting for More Efficient and Accurate Assessments

Behavior Imaging technology facilitates clinical decisions based on child behaviors captured as they occur in natural settings. In contrast, the current practice of observing the child in a specialized room at a clinic may produce reactivity effects in the child, both those introduced by a novel environment and unfamiliar observer (Gardner, 2000; Kazdin, 1982). Moreover, for many interventions like those targeting challenging behaviors, a key component of treatment planning involves understanding the function of the behavior. However, the stimuli that evoke the behavior as well as consequences that maintain it in the natural environment may not be observed in an artificial setting like a clinic.

parentconcern_psd-e1379549490516-150x150Thus, Behavior Imaging technology allows for families and caregivers to capture not only the behavior, but what happened right before it (i.e., antecedent) and what happened right after (i.e., consequence). With this knowledge, practitioners are able to further understand potential triggers for problem behaviors and actions that may be maintaining its occurrence. Results of a multi-site (Oberleitner et al., 2007) user study identified a need for this technology in the process of behavior assessment, supporting teaching practices, increasing administrative support, and the ability to gain input from experts in the field.

Enabling Collaboration between Families and Professionals

Behavior Imaging technology will further enable collaboration and consultation between families and professionals through a secure health record application that allows users to store, share, and annotate captured video. Our long-term vision is that this telehealth system will to a great extent replace current practices to provide patients with diagnoses and treatment plans based on information that is collected in natural environments, and is thus more ecologically valid. At the same time, our system will make more efficient use of professionals’ time and reduce office visit times for patients and their families. By providing a format for collecting and analyzing visual evidence, both diagnosis and treatment efforts will translate into a streamlined approach that is ultimately more reliable and cost effective for practitioners and families.

About The Autism Speaks Grant

Telehealth System to Improve Medication Management of ASD Remotely

City: 
Boise
State/Province:
ID
State/Province Full: 
Idaho
Country: 
United States

Behavior Imaging Solutions (BIS) has developed and successfully demonstrated a unique “telehealth” (or “e-visit”) technology platform called Behavior Imaging® (B.I.). Project would enhance this platform to help doctors more effectively administer evidence-based practice to address the scarcity of psychiatric services for the autism community via providing enabling technology to facilitate ‘medication management’, while providing doctor more contextual data from the patient’s natural environment. Company seeks to enhance its Behavior Connect platform – a HIPAA conforming online Consultation and Records Environment. It includes a personal health record, proprietary behavior imaging review tools, and other relevant functionality to facilitate remote interaction between families and their doctors who manage ongoing medication needs of these patients By enhancing the way a family can securely share prescribed captured video et al. health data from their home, the platform can facilitate a unique way to perform “e-visits”, which allow doctors to analyze – asynchronously – natural-environment behavior videos and other caregiver input quickly and efficiently. The resultant data that can be archived in the Behavior Connect platform may also have important implications to help a doctor: 1. better track patient progress longitudinally, and 2. gather unique naturalistic environment data that doctors can code to enrich their understanding of their patients’ behavioral phenotypes.

A Novel System for Supporting Autism Diagnosis Using Home Videos: Iterative Development and Evaluation of System Design (Technical Monograph)

Active Conference Schedule for 2015

Upcoming:

International Autism Research Meeting 2015 (IMFAR) May 13 – May 16 at the Grand America Hotel in Salt Lake City, Utah. Behavior Imaging presentations include:

  • NODA-clinical-study-parent-feedback-IMFAR-poster-May2015Analysis of Parent Responses to Using a Remote Autism Diagnostic Assessment System (NODA): A remote autism diagnostic assessment system was designed through a series of research studies conducted with clinicians and parents of children with autism. Through In-home evaluation parents confirmed that capture system facilitated a simplified capture experience. Currently through a systematic study, diagnostic assessments conferred through the proposed system are being compared with in-person diagnostic assessments.

  • IMFAR 2015 NODA FinalComparing Remote Diagnosis of ASD (NODA) to In-Person Assessment: Study – To compare a novel telehealth approach to diagnosing ASD to the gold standard, in-person assessment. Conclusion to the study provided that raters can accurately diagnose ASD with NODA for most cases. A small percentage of participants, particularly high functioning children with few observable behaviors may require an IPA.

  • IMFAR Pharma Trial Poster, - 051112015NODA to Improve Pharmaceutical Trials: Study – To provide a method for centralized assessment of inter-rater reliability for key assessments in a multi-site pharmaceutical trial. Conclusion: Study demonstrated practicality and ease of the BI technology to facilitate and document inter-rater reliability in pharmaceutical trials. Study also provided that use of this platform can help to improve the integrity of data collected at sites in a more efficient manner than is currently applied.

CCSSO Council of Chief State School Officers: National Conference on Student Assessment (NCSA 2015) June 22 – 24, Manchester Grand Hyatt, San Diego, CA.

  • The primary objective of the NCSA is to promote sharing of information and best practices that will help states achieve their educational purposes through having the strongest assessment systems possible. This year the conference theme is “Implementing High-Quality Assessments for ALL Students.” The goal of the 2015 conference is to provide a forum for states to share the best practices, strategies, lessons learned, and available resources relative to their implementation of high-quality assessments for all students.

Association for Behavior Analysis International: 41st Annual Convention – San Antonio, TX (ABAI) Poster (Marcus Autism Center, Children’s Healthcare of Atlanta, Emory University School of Medicine, Center for Leadership and Disability, Behavior Imaging):

  • ABAI-Autism-Poster-SBIR-final111111Feasibility of Conducting FBA’s in the Schools with Web-Based Video Recording Technology: Purpose of Current Study: To determine the efficacy of using web-based video recording technology to conduct functional behavioral assessments (FBA’s) in the schools for children with ASD or related disorders, in addition to exploring the cost-benefit )i.e., time and money) of using telehealth for FBA’s in the schools when compared to archival records of FBA’s conducted in person (I.e., traditional approach). Download

Applied Human Factors and Ergonomics 2015 (AHFE):

  • Use of a Novel Imaging Technology for Remote Autism Diagnosis: Applied Human Factors and Ergonomics Conference 2015 (AHFE International)July 26th – 30th, Caesars Palace Hotel, Las Vegas, Nevada, USA. Prevalence of Autism Spectrum Disorder (ASD), in children in the United States has significantly increased form 1 in 150 in 2000 to 1 in 68 in 2010. While the cause of this neurodevelopmental condition is unknown, clinical evidence has shown that early diagnosis and early intervention are critical to improving the long term functioning of a child with ASD. However, a major challenge facing parents is difficulty in obtaining on-time access to appropriate diagnostic services. To address this need, an imaging technology, NODA ® (Naturalistic Observation Diagnostic Assessment), has been successfully developed and field-tested.

Recent:

20th Annual Telemedicine Meeting & Trade Show (ATA 2015) May 2 – 5, Los Angeles, Booth # 1430.

  • Telemedicine for Autism Collaborators: Treatment – Behavior Connect is an online portal that enables health and education professionals and their organizations to remotely interact with clients, specialists and other staff members, while building a library of shareable assets and a continuous health record. Better manage your: Records (a video record annotated for assessment, communication between users/clients, Functional Behavior Analysis, training or second opinions), Therapy and In-office Visit Intervals, Treatment Options and Capacity, Treatment Gaps, & Remote Technology – Distance and Time Gaps.
  • Southwest Autism Research & Resource Center (SARRC) hosted its 17th Annual Community Breakfast “Take The Next Step” on Friday, April 24th, 2015 at the Arizona Biltmore’s Frank Lloyd Wright Ballroom. The goal of the Breakfast was to raise funds for SARRC’s outreach, education and research programs and inform individuals about autism, which is now the most prevalent children developmental disorder in the United States, affecting one in every 68 children born today.

SARRC Outreach Magazine (Spring 2015) NODA:

Positive Feedback from Clinicians and Researchers at Important Industry Conferences

Throughout this fall, Behavior Imaging has been kept busy with invitations to key conferences in psychiatry (AACAP), education assessment (CCSSO), and disability (AUCD). Principle investigators in ongoing studies on behavior imaging technology and Behavior Imaging executives have presented NIH-backed research, trained investigators, and received a prestigious innovation award while continuing to receive feedback and foster connections among industry researchers and professionals at each conference.

NIH Naturalistic Observation Diagnostic Assessment Project at AUCD

The Naturalistic Observation Diagnostic Assessment (NODA) from Behavior Imaging’s current NIH research project made an impact at the 2013 AUCD conference this month. SARRC’s Director of Research Dr. Christopher J. Smith presented on how NODA is designed to speed up autism diagnostic assessments. Behavior Imaging Solutions’ exhibit also allowed CEO Ron Oberleitner and others to talk about and demonstrate how Behavior Capture and Behavior Connect can revolutionize the way the disability community can diagnose, assess, and treat behavior disorders. The launch of Behavior Connect 2.0 and a suite of related smart phone apps have opened a lot of new opportunities for the behavioral health industry, including faster diagnosis and better oversight capabilities for supervisors.

Training Investigators and Expanding Our Apps’ Uses at the AACAP Annual Conference

Ron Oberleitner, CEO of Behavior Imaging Solutions, has been keeping busy attending several conferences this fall, including the 60th Annual Meeting of the American Academy of Child and Adolescent Psychiatry (AACAP) in Orlando, Florida late in October. At the conference, Ron and his team demonstrated our Med smartCapture App for dozens of doctors, researchers, and professionals and we were pleased to discover several new uses for this app. Some talked about its potential as a way doctors could stay connected with international or long-distance practices or research projects while others were interested in how it would help during pharmaceutical clinical trials. Most exciting, Ron and his team also trained investigators of a National Institute of Mental health-backed study on the use of Behavior Connect for another upcoming study using this technology.