#083: Telehealth and Autism | Interview with Telehealth Professional Dr. Ally Patterson

telehealth

I really believe that parents are the captain of the family ship, and experts like Dr. Ally Patterson and myself are here to help make things better onboard. Dr. Patterson is a Board Certified Behavioral Analyst-Doctoral (BCBA-D) who is passionate about early intervention. But at the beginning of the pandemic, she realized the shutdown could cause her clients to lose progress, so she quickly had to adapt her practice to reach them using telehealth.

There can be so many barriers to good ABA therapy for a child: the waitlist for a diagnosis, insurance coverage, finding a great therapist, and copays. By flexing to virtual appointments, Ally has found that she can make herself a little more accessible to her clients.

As she approaches every appointment, Ally simplifies her goals so that parents can help her reach the desired outcome. She lays out three guiding principles that she follows for each of her appointments. She discusses why she chose these three principles as well. From the parent side, Ally has some advice on how parents can make telehealth appointments an effective tool for helping children succeed.

Of course, there are also some drawbacks to telehealth therapy. A parent’s or caregiver’s help on the other end of the screen is a necessary component to telehealth, and sometimes parents don’t have that time to give. But Ally’s seen some really positive benefits from having a parent even more involved in therapy, and she’s also seen how parents can use an “all hands on deck” approach that lets them access care despite barriers.

I see telehealth as such an important part of our future in ABA, and I’m really thrilled to watch another therapist use it to reach more families. Utilizing telehealth has given many parents the chance to become better captains of their family’s ship.

TODAY’S GUEST

Dr. Ally Patterson is a Board Certified Behavior Analyst- Doctoral (BCBA-D) practicing in the Washington, D.C. metro area. Her interest in ABA developed as an undergraduate at Furman University and continued as she earned her Ph.D. in Applied Developmental Psychology from George Mason University. She consults with families in her private practice, Patterson Behavior Services, and is passionate about early intervention for children of all abilities. Her background in both developmental psychology and behavior analysis gives her special insight into the importance of each child’s early years, as well as how to promote best outcomes across their lifespan. You can find her online at pattersonbehavior.com!

YOU’LL LEARN

  • How to structure a telehealth meeting so that parents and children get the most out of it.
  • Tips for parents to help them support the work that’s done in a telehealth appointment.
  • How telehealth can potentially help ease the backlog of cases waiting to be seen by professionals.
  • How to decide when telehealth won’t work and when you should return to in-person meetings.
  • 3 principles that Dr. Patterson relies on for every telehealth appointment.
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Transcript for Podcast Episode: 083
Telehealth and Autism | Interview with Telehealth Professional Dr. Ally Patterson
Hosted by: Dr. Mary Barbera

Mary: You're listening to another episode of The Turn Autism Around podcasts. I'm your host, Dr. Mary Barbera. And today I have a special interview with Dr. Ally Patterson, who lives and works in Virginia through her own limited liability company. She is servicing kids with autism, toddlers, she even has a few teenagers. But I wanted to interview her because Ally got thrown in the world of telehealth intervention because of COVID. She joined my online course and she learned some great techniques through my course that she implemented the telehealth. So today we're talking telehealth and Ally's journey and some tips for both parents and professionals. I think you're going to love this one.

Mary: Well, since I'd like know almost nothing about you. Why don't you tell me a little bit about yourself? Like, how did you get involved with the whole autism world?

Dr. Ally Patterson: Sure. So I actually started out. I wanted to be a researcher. I wanted to be a professor. So I was in a program for developmental psychology. And along the way, I mean, there's lots of overlaps in those two fields. And so I had friends who were doing ABA. And basically I needed a job. And so I tried it out and just loved it. And I already loved kids, obviously. But it was so much more fun seeing the progress and helping people in person rather than, you know, looking at datasets full of outcome data and doing analysis and things like that. So I just fell in love with it.

Dr. Ally Patterson: Like my first kid was just the ideal child, like no problem behaviors and just learned so rapidly. And of course, I thought, you know, every child would be like that. So that kid really made me fall in love with ABA.

Mary: Yeah. What year was that?

Dr. Ally Patterson: That was 2015. Oh, wow. And where do you go to college? Well, grad school at George Mason, which is in Virginia, up to D.C.

Mary: I think I presented there once, with, oh I'm blanking on his name. Who was a professor there?

Dr. Ally Patterson: Maybe Ted Hoke?

Mary: Yeah. Ted Hoke. I'm like, I know that. I'm friends with him. Yeah. So I presented for Ted down there and yeah. That was several years ago, probably before you were there. So that's great. So are you still in Virginia?

Dr. Ally Patterson: Yes. So I finished the PhD, started an LLC and was just doing some contracting, but now I've grown a little bit and have a couple RBTs, so I work for myself.

Mary: You have your own company? All right. Good, good. OK. So interesting. Like you posted within our toddler or preschool or course about the fact that during COVID you found my online course and you thought you would take it to see if you could improve telehealth with your young clients. So I'm just wondering, with telehealth, new sense coalbed or, you know, what are your experiences with telehealth even before you learned my techniques?

Dr. Ally Patterson: None. Before that, prior to this, I didn't have any funding sources that paid for telehealth at all. And so the family I was really thinking when I signed up for your course, they were brand new to ABA. So I was doing the assessment and finishing up right as everything started shutting down. And I also have kind of a language barrier with them. They're originally from India. And so I was thinking, like, I need really, really simple language to break this down for people.

Dr. Ally Patterson: And as you know, remembered your book and thought maybe this will be something that will work for them. Yeah. That's great techniques. I think I try and explain it, like, in the ways that you do. Whereas when I'm in person, I'm realizing I have the tendency to go to jargon and kind of like take over a little bit, which you can't do through telehealth. So it's been really helpful.

Mary: Yeah. So on telehealth, the children, do just see the really young kids or are you seeing older kids as well?

Dr. Ally Patterson: I have mostly younger kids. I do have one teenager, but he's VB-mapp level two and three.

Mary: So developmentally, younger than a four year or five-year-old. Yeah. So for the little kids with telehealth, what are some of the key strategies you learned by taking the course and doing telehealth more? I mean, kind of coincided together, but what are some of the poor professionals out, you know, in the world who are intimidated by telehealth or are not really having much success? I know there's a lot of parents, too, who are struggling. They're just seeing it as a waste of time to get on that teleconference. And they have to be there and their child's having problem behaviors like what are the key elements that that you took away from the course that's really helping. Besides breaking things down and not doing so much jargon?

Dr. Ally Patterson: Yeah, I think starting with just the pairing programs. My first tactic was like, I'm just going to try and condense an entire graduate education into, you know, our first session and just tell you everything. Obviously, that didn't work. So I started with pairing programs and then I would pick, I called it goal of the day. Again, language barrier, trying to make it really simple. I'd pick a goal of the day. Today's goal is he's going to point to request his snack. That's it. That's what we're doing today.

Dr. Ally Patterson: So do it like introducing one little tiny goal at a time within the context of your pairing ideas was probably the most helpful. And then now, like, I can give them three goals of the day, but it just took a long, long time to get there.

Mary: Yeah. And how often are you seeing or were you seeing kids telehealth?

Dr. Ally Patterson: Still doing it. Started it.They were pretty skeptical, I think, of telehealth as kind of, was I. So I was just seeing them maybe twice a week at the very beginning. And then they wanted every day and now they want more than every day. So six, six hours a week is what is what we're doing now.

Mary: OK. And so you're really seeing some nice gains. Are you mostly coaching them at a table or?

Dr. Ally Patterson: So our sessions are usually sitting on a little table. But then I meet with them just to talk to the mom and the dad. The dad's usually at work. So I talk to the mom and dad about natural environment stuff. Then we practice a little bit of that on that one session. Most of our sessions are on the table.

Mary: Yeah. Is that I know a lot of people, you know, they think early learner VB-mapp level one, you should have them in the natural environment 90 percent of the time. But I really found over the years and part of my approach is actually pairing up the table. I think for telehealth it's even more important because if you had to chase around the child with the computer and then resituate, I didn't even think about that. But regardless, I have found over the years is that if we can pair up a small table for young children or card table for older children, we'll get more trials in, will get more success, we'll have more ability to control the trials, and the reinforcement and we'll just see much greater success.

Mary: So a lot of the early intervention professionals are used to and are trained and trained parents on the importance of natural environment teaching, sitting on the floor and following the child's lead. But the problem with following the child's lead, especially if a room isn't really sanitized, is that when you have a darty kid who's picking up this and you might get one label out of it and then they're running to the window, and then you might be pointing out, oh there's a tree. And then meanwhile, you know, a half an hour has gone by and the child hasn't even responded.

Mary: Yeah. And a lot of it I mean, everyone is very well meaning. And they've been taught, you know, within their paradigm. So, you know, generally, say, a speech pathologist is going to be less like into a pacifier use than an occupational therapist who would be saying potentially that the child needs that pursue the thing and that that's a good technique. So then you have one well-meaning professional saying we need to stop the pacifier because it's impeding his articulation or he's not talking. We have him plugged up and then we have another professional going in the next day who's giving the opposite advice. So it can be very, very confusing to parents. And I am a big believer in weaning from pacifiers.

Mary: And I think the addiction to pacifiers and bottles is one of the biggest issues I see in very young children a lot. And it does affect their speaking, but it also affects their behavior. So it sounds like I did early intervention for many years from 2010 to 2016 17. I've worked with multidisciplinary teams. And my new book, I don't know. Do you know I'm writing a new book now, so I have a new book coming out in April. And it's always going to be for kids one to five with all of these techniques.

Mary: Basically, my techniques in the toddler preschooler course in a book. And of course, it's still going to help those older kids and even teens who are functioning at a one to five-year-old level. It's also going to help professionals, but it's really going to be geared towards parents of kids with autism or signs of autism, because that's a huge issue, too, is waiting for the diagnosis. And the wait lists are horrendous. Do you see that in Virginia?

Dr. Ally Patterson: To be diagnosed or to get service? Yeah. I'm near Kennedy Krieger, and last I heard they're over a year to be seen for a diagnostic test. And then going back to that early intervention, I'm thinking about one little guy who was finally got in to see his pediatrician, and he gets his diagnosis. And they tell him, you know, you need intensive ABA, like this kid has really big deficits here. And other professionals are telling them, no, he's so little like he doesn't need all this help. Like, just wait. Just wait.

Dr. Ally Patterson: Like telling them go against the advice of your doctor. And so the family's confused and he's not getting the help that he needs. Yes, I see all kinds of that kind of thing.

Mary: And all kinds of stress related to waiting. So do you see telehealth like as a good option going forward, even if physically we can go back into homes?

Dr. Ally Patterson: For some people, for the parents who are willing to sit and be the RBT? Yes, definitely. But I've also gotten parents who basically just want to use an hour a week and just kind of talk about all the problems and not work towards solving them. So for them, probably not as effective.

Mary: And how about as a business owner, are you struggling with insurance and OSS and decrease in hours and all that stuff?

Dr. Ally Patterson: I will say see the first two weeks of it. I didn't work at all. And I was like, oh no, this is gonna be terrible. This is going to ruin everything. I mean, I jumped onto the telehealth thing as fast as I could and tried my best to figure it out. And it's like so, so far so good. Fortunately, it was a scary couple of few weeks. What about you? Have things changed for you?

Mary: No, not really, because I don't see clients anymore. I haven't for a couple of years. I've been all online. Actually, there's more interest than ever in my courses and learning this stuff online. And so, yeah, for me, for my business, it's good.

Dr. Ally Patterson: Yeah. That's what I would have guessed.

Mary: And people are really consuming the course of they're just not buying it. They're like, OK, I've got to consume this. I'm seeing progress. And so the more people that post that they're making progress like you posted within the online community, which is how I thought that I wanted to interview you, is because people are posting success, then it's like, OK.

Mary: Then other people see, OK, I just make a schedule and start watching these videos and start incorporating these techniques it's all going to work out, you know, but as you said, these kids are at very different levels. You know, some kids are not speaking at all. Some kids are speaking. It it is confusing. And that's why the more we can simplify things, the better, you know, for everybody.

Dr. Ally Patterson: Sometimes I would give people the chapters of your book to read and they'll read it and talk about it. And they love that you are an autism parent because, you know, I'm not even a parent at all. I think there's that extra special thing that comes from reading another parents' experience.

Mary: But you are, even though you're not a parent and you're a BCBA-D, right? You know, you are looking at resources that is going to get you closer and closer to be able to address the needs of a variety of parents, you know, which is really helpful because I've found that if you don't put the parent in the captaincy, you know, and allow them to really coordinate things and roll up their sleeves, you know, the whole I just want to be a parent thing. It's like, well, that's what parents do. They teach their kids to talk to potty train, sleep in their own bed. I mean, that's all what we're doing as a parent. You can't kind of outsource that and you will be with your child for life. So you have the biggest vested interest in helping them. And I think the more we can collaborate as parents and professionals, the better, obviously. So, you know, I'm hoping that my courses and my new book will really address those kinds of issues in the crossroads.

Mary: So can you tell me, like, if somebody was brand new to telehealth, what general advice would you have for them? Let's say for the professional. If you were brand new to telehealth, what are some things that you would be like, you got to do this thing.

Dr. Ally Patterson: I would definitely say don't overwhelm the parent or they will quit. Keep it really, really simple. I also like to have like a written plan for the day, not necessarily that I share with the parent, but just like a couple of things that I want to accomplish because sometimes we can get off track. You start talking and talking. We don't actually get anything done. I like to have a written plan. I think the one goal of the day thing has been really successful for me and keeping myself from overloading people with information.

Mary: Besides like pointing for a snack. What are some other one goals of the day that you've done?

Dr. Ally Patterson: Well, I mean, for this kid, we�re doing all kinds of different things now. So, like, the goal for the day might have been we're going to work on our echoics today. Now, the mom knows what that means. Or today we're going to shoot for three minutes of independent play with just a few prompts for you. So now it's basically just like the goal of the day is a program. But in the very beginning, it was things more like goal of the day is notice what he is going, if you can do anything, like what is he going for? Those are his reinforcers. Let's make notes of that. Or notice when is he more likely to look at you, to get your attention rather than grab your hand and put it on what he wants.

Mary: Which is called hand leading, which I talk about. Yes. Yeah. That's good. So don't overwhelm, have a written plan for yourself so you don't get off track. Have a goal for the day and share that with the parent.

Dr. Ally Patterson: Yeah. They also probably don't expect the parent to take any data. I mean, I've gotten massive pushback when I've even seen parents take data.

Mary: Yeah. Do you ever ask the parents to get a clicker like this?

Dr. Ally Patterson: I have in the past, but everybody just tells me that they could do it on their phone. So there's this app called Tally that sometimes parents will use, but the same concept.

Mary: Yeah. I like the clicker counter because, well, one of the things if the kid likes your phone and like certain videos on your phone, you know what I mean? And this is just handy. It's like a kitchen timer. I find like some of the things it's better to have physically because you can just grab it. You could just count it for, you know, fifteen minutes or whatever. Sometimes when you're like, I can do it on my phone, it just doesn't happen.

Dr. Ally Patterson: Right.

Mary: Yeah, but yeah, I use a clicker counter. I recommend that, but. OK. I like the; don't expect the parent to take data. Anything else? Do you, like, summarize the sessions at all? Like, before you get off the phone or get off?

Dr. Ally Patterson: Yeah. And actually I usually end with, is there anything else that you want to talk about? And a lot of the time they will say things that it never even would've occurred to me to ask them. So I usually I always end with like five minutes before the end. I have some kind of open-ended question about anything we didn't get that day.

Mary: And then if it's too much, you can be like, OK, well, I'll prepare for next time to really, we�re going to dive in more. We'll come up with some way to keep data or, you know, some way to assess that more next time.

Dr. Ally Patterson: But it's usually something like very random, almost. Like something I had never even thought of.

Mary: I think those are great tips for professionals. Now, what about for parents? If they are going to start telehealth for the first time, what are some tips that make it easier to work with parents?

Dr. Ally Patterson: Probably that they're going to have to really carve out the time in less. I mean, I don't work with any kids like this, but I know that there are older kids who just have social deficits who will look at the screen and talk to the I guess having that time available and if they don't have that time available, then maybe in person really is the better way to go.

Mary: Or they could hire a babysitter or I've had grandmothers who joined my courses and really rolled up their sleeves and did the work of getting, you know, learning how to pair up different materials and made tons of success. So it could be a relative. It could be a babysitter or mommy's helper. Could be an older sibling. If you don't have the time.

Dr. Ally Patterson: I think we also, or me at least, sometimes we tend to like revert back to that jargon thing. So I would tell parents, please interrupt me if you are confused and ask questions like that. And I always get like not just with parents, but with texts too. I think people are nervous to be observed. Once they feel that, you know, they're being criticized or judged. So what I talk about how, you know, like I'm not judging you. I'm here to help you. That sort of thing seems to calm people down a little.

Mary: Yeah. I think those are excellent tips for both professional and parents, because I think telehealth and learning online and learning how to do things, you know, is the quickest way to see success. And, you know, waiting in line for diagnosis, waiting in line for insurance coverage, waiting in line for BCBA and an RBT to get scheduled, paying co-pays. And then, you know, something like COVID happens and then in driver's seat anyway. And so that's been my whole mission is to get parents to be the captain of the ship and then use experts like you to really help fine tune things and make things so much better. Because when I see people posting online.

Mary: You know, I got my child from, I just had an interview podcast that came out recently with Michelle, whose daughter went from two words to five hundred words within 60 days of my course with COVID shut down with no other services. And it's like. You know, when you see that kind of gains, you're just like, whoa, you know, like that could happen. But, you know, it may take a lot more time than two months. But I think we just all need to work together as parents and professionals to help each child reach their fullest potential. But it's amazing what you can learn online and not have to keep waiting in line. And even if you have somebody good like you like to see a child 10 hours a week online, the more the parent can learn on their own.

Dr. Ally Patterson: OK. This was my favorite part of the whole thing. So I've explained the basics to them. And I knew this kid had problems with eating. When I assessed him, he was literally running around the room while mom chased and wanted him to open his mouth for some candy and then, like, stuck some eggs in his mouth. It was terrible. But they have a feeding therapist who does the whole, like, you know, touch your food, kiss your food.

Mary: Like sensory, orals. Yeah. Sensory modality for feeding.

Dr. Ally Patterson: Yeah. But so after they learn some of the basics, the mom is like, oh, you know, I tried the ABA thing with this, with his eating. And I was like, You did what? She said she has him sitting down for a meal and he eats some amount of bites and then he gets to watch a little video and she's like, he's calm. I'm sitting there. I'm eating my meal, too. Like, I haven't done that with him ever. He's not screaming. He's not throwing foods. And like, I didn't tell her to do that. She just kind of took the pieces and figured it out herself. So that's probably my favorite part of the whole thing.

Mary: Yeah. That's awesome. OK. So thanks so much for joining me today, Ally. It's been great. I think you gave some great tips on telehealth for both professionals and parents. And I see it as being such an important part of our ongoing future in the field, the baby. So before I let you go, I always like to end my podcast. Part of my podcast goals, as you listeners probably know by now, is that to be parents and professionals, to be less stressed and lead happier lives. So do you have, Ally, any self-care tips or stress reduction strategies that you use that you would recommend to parents and/or professionals?

Dr. Ally Patterson: Just like in our ABA sessions, I think it always goes back to pairing. So if you're having a difficult time with your child or with any of the other people that you're quarantined, wish go back to parent. Think about what it what is it that I do with my child or even by myself that makes me enjoy the process of parenting. So if that's watching special movie together or playing a game and keeping things, keeping things fun, having a good time with your child, I think that's some of the best stress relief that you can do during this time.

Mary: Awesome. Well, thanks again for your time, and I look forward to seeing you within my online courses and community. I'm so happy that you found us and so happy for your support.

Dr. Ally Patterson: Thank you so much.