This is a summary of a recent research paper called Connecting People with People: Diagnosing Persons with Fetal Alcohol Spectrum Disorder Using Telehealth. For a detailed understanding of this subject matter, please read the full article.

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Background

Researchers have shown that obtaining a formal FASD diagnosis can benefit individuals and their families. Benefits include access to treatment, knowledge of challenges and strengths, and information on potential secondary outcomes. Despite these benefits, the diagnostic process is rarely a positive experience for individuals and families and may cause significant stress. Geographical location in remote and rural settings can be a significant barrier to receiving specialized FASD services or accessing a formal diagnosis.

Because of Canada’s wide geographic range, the medical community has had to come up with innovative ways to make sure rural and remote communities have access to health care. Telehealth – providing health care services over distances using technology, like telephones, computers, and emails – has been used in the medical community for decades to connect communities. Telehealth has been suggested as an effective means of providing FASD assessment and diagnosis to rural and remote communities. However, only three Manitoba-based studies have explored the effectiveness and experiences of FASD telehealth programs.

The authors of this literature review explore the use of telehealth and developmental disabilities and provides recommendations for how telehealth can be used during FASD assessment and diagnosis in Canada.  

Main findings

There are many advantages and barriers for the use of telehealth.

Advantages:

• Ability to connect health professionals from urban cities with patients from different remote and rural communities.
• Increased participation from other stakeholders and members of the individual’s support team, such as teachers and parole officers.
• Supports the development of more comprehensive treatment plans, including both medication and behavioural interventions, specific to the home community 
• Reduced operating costs for clinics and reduced travel costs and time for families.
• Ability to address concerns quicker, and with shorter waitlists, ensuring early intervention for youth in rural and remote communities.

Barriers:

• Limited access to technology, such as a lack of high-speed internet, which can prevent professionals from making accurate observations and building relationships with patients.  
• Individuals’ and professionals’ lack of experience using the technology for assessment and diagnosis can increase difficulties.
• Lack of technological infrastructure in remote areas, including slower and less reliable internet.
• Communication challenges, such as language barriers.
• Inadequate health policies, protocols, and guidelines to guide the use of telehealth.

Recommendations

Recommendations are divided into three areas:

1. Technological recommendations:
   • A need for dedicated team members who know the technology and equipment and are confident in how to use it.
   • Team members trained on how to use technology to facilitate communication.
2. Child and family-centered recommendations:
   • Telehealth should consider the unique health and social needs of the community, including cultural sensitivities.
   • Individuals and families should be aware of the telehealth process beforehand and planning should consider the pre- and post-clinic support needs.
   • Create a supportive, inviting, respectful, and welcoming environment is needed. For example, some strategies may include: improving the physical assessment spaces by limiting the amount of people allowed in the room during assessment; providing light refreshments; providing child-care services for families; and setting up the room to be child-friendly.
3. Team-based recommendations:
   • Budget for staff, equipment, and the setup of the physical telehealth location, as well as training for team members and other professionals involved.
   • Encourage site visits to get to know the physical location and team members.
   • Create a standardized guideline for telehealth assessment, including identifying other professionals who may improve the assessment process and when an in-person assessment is beneficial.
   • Appoint a regional FASD Diagnostic Coordinator for supporting families in their home community.

Take home message
Telehealth approaches to FASD assessment and diagnosis in rural and remote areas will improve the barriers that individuals with FASD often face by increasing accessibility and cost effectiveness and improve family and community supports.

Authors: Lisa M. Whittingham & Kelly D. Coons‑Harding

Journal: Journal of Autism and Developmental Disorders

Date: July 9^th 2020

Read the full article