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Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults: Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals

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Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults : Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals. / Spain, Debbie; Stewart, Gavin R.; Mason, David et al.

In: JMIR Mental Health, Vol. 9, No. 7, e37901, 01.07.2022.

Research output: Contribution to journalArticlepeer-review

Harvard

Spain, D, Stewart, GR, Mason, D, Milner, V, Fairhurst, B, Robinson, J, Gillan, N, Ensum, I, Stark, E & Happe, F 2022, 'Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults: Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals', JMIR Mental Health, vol. 9, no. 7, e37901. https://doi.org/10.2196/37901

APA

Spain, D., Stewart, G. R., Mason, D., Milner, V., Fairhurst, B., Robinson, J., Gillan, N., Ensum, I., Stark, E., & Happe, F. (2022). Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults: Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals. JMIR Mental Health, 9(7), [e37901]. https://doi.org/10.2196/37901

Vancouver

Spain D, Stewart GR, Mason D, Milner V, Fairhurst B, Robinson J et al. Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults: Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals. JMIR Mental Health. 2022 Jul 1;9(7). e37901. https://doi.org/10.2196/37901

Author

Spain, Debbie ; Stewart, Gavin R. ; Mason, David et al. / Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults : Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals. In: JMIR Mental Health. 2022 ; Vol. 9, No. 7.

Bibtex Download

@article{82cff3d32fca42a284965509fe47ca7f,
title = "Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults: Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals",
abstract = "Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals{\textquoteright} experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals{\textquoteright} experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.",
keywords = "autism, autism diagnostic assessment, clinical supervision, COVID-19, COVID-19 pandemic, health professionals, telehealth, training",
author = "Debbie Spain and Stewart, {Gavin R.} and David Mason and Victoria Milner and Bryony Fairhurst and Janine Robinson and Nicola Gillan and Ian Ensum and Eloise Stark and Francesca Happe",
note = "Funding Information: The authors would like to thank the health professionals who participated in the study. Publisher Copyright: {\textcopyright} Debbie Spain, Gavin R Stewart, David Mason, Victoria Milner, Bryony Fairhurst, Janine Robinson, Nicola Gillan, Ian Ensum, Eloise Stark, Francesca Happe.",
year = "2022",
month = jul,
day = "1",
doi = "10.2196/37901",
language = "English",
volume = "9",
journal = "JMIR Mental Health",
issn = "2368-7959",
publisher = "JMIR Publications",
number = "7",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Telehealth Autism Diagnostic Assessments with Children, Young People, and Adults

T2 - Qualitative Interview Study with England-Wide Multidisciplinary Health Professionals

AU - Spain, Debbie

AU - Stewart, Gavin R.

AU - Mason, David

AU - Milner, Victoria

AU - Fairhurst, Bryony

AU - Robinson, Janine

AU - Gillan, Nicola

AU - Ensum, Ian

AU - Stark, Eloise

AU - Happe, Francesca

N1 - Funding Information: The authors would like to thank the health professionals who participated in the study. Publisher Copyright: © Debbie Spain, Gavin R Stewart, David Mason, Victoria Milner, Bryony Fairhurst, Janine Robinson, Nicola Gillan, Ian Ensum, Eloise Stark, Francesca Happe.

PY - 2022/7/1

Y1 - 2022/7/1

N2 - Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals’ experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals’ experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.

AB - Background: Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. Objective: This study explored health professionals’ experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. Methods: A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. Results: Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals’ experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. Conclusions: A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.

KW - autism

KW - autism diagnostic assessment

KW - clinical supervision

KW - COVID-19

KW - COVID-19 pandemic

KW - health professionals

KW - telehealth

KW - training

UR - http://www.scopus.com/inward/record.url?scp=85136852541&partnerID=8YFLogxK

U2 - 10.2196/37901

DO - 10.2196/37901

M3 - Article

AN - SCOPUS:85136852541

VL - 9

JO - JMIR Mental Health

JF - JMIR Mental Health

SN - 2368-7959

IS - 7

M1 - e37901

ER -

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