TeleABA for Hospitalized Adolescents and Young Adults With Autism Spectrum Disorder

Official title

Transforming Hospitalizations of Autistic Adolescents Via a Novel ABA Telehealth Platform

Overview

This study is evaluating whether a telehealth-based applied behavior analysis (ABA) program can improve the care of adolescents and young adults with autism spectrum disorder (ASD) who are hospitalized because of severe challenging behaviors, such as aggression, self-injury, property destruction, or elopement. Participants will be randomly assigned to receive either standard hospital care alone or standard hospital care plus a Telehealth Applied Behavior Analysis for Hospitalized Adolescents and Young Adults With Autism Spectrum Disorder (TeleABA) program. The TeleABA program includes assessment by a Board Certified Behavior Analyst (BCBA), individualized behavior support recommendations, coaching for hospital staff, caregiver training, discharge planning, and four weekly telehealth sessions with caregivers after the participant leaves the hospital. Researchers will compare the two groups to determine whether the TeleABA program improves behavioral outcomes, caregiver confidence and stress, hospital experiences, and the transition from the hospital to home. The findings may help identify more effective ways to support individuals with autism and their families during and after behavioral health hospitalizations.

Detailed description

Adolescents and young adults with autism spectrum disorder (ASD) who require psychiatric hospitalization because of severe challenging behaviors often have complex behavioral support needs that may not be fully addressed through standard inpatient care alone. Behavioral crises during hospitalization can contribute to prolonged length of stay, increased use of restrictive interventions, caregiver distress, and challenges during the transition from hospital to home.

This randomized controlled trial will evaluate whether adding a Telehealth Applied Behavior Analysis (TeleABA) intervention to standard inpatient behavioral health care improves clinical, caregiver, and hospital outcomes compared with standard hospital care alone.

Participants will be randomly assigned in a 1:1 ratio to receive either standard hospital care or standard hospital care plus TeleABA. Standard hospital care includes routine inpatient behavioral health services provided by the treating hospital, including psychiatric evaluation, medication management, nursing care, therapeutic programming, and discharge planning.

The TeleABA intervention is delivered by a Board Certified Behavior Analyst (BCBA) and includes caregiver interviews, behavioral assessment, functional assessment when indicated, individualized behavior support recommendations, consultation and coaching for hospital staff, caregiver training, discharge planning, and four weekly telehealth caregiver coaching sessions following hospital discharge to support implementation of behavior support strategies and continuity of care.

The primary outcome is change in irritability measured using the Aberrant Behavior Checklist-Irritability (ABC-I). Secondary outcomes include clinician-rated improvement and severity, hospital length of stay, use of restrictive interventions, caregiver transition outcomes, and family perceptions of care. Assessments will be conducted during hospitalization and through 6 weeks after hospital discharge.

Interventions

• Behavioral Standard Hospital Care
  Standard inpatient behavioral health care provided by the hospital, including psychiatric evaluation, medication management, nursing care, therapeutic programming, and discharge planning in accordance with routine clinical practice.
• Behavioral Telehealth Applied Behavior Analysis (TeleABA)
  The TeleABA intervention is a telehealth-delivered applied behavior analysis (ABA) program designed to support adolescents and young adults with autism spectrum disorder during hospitalization and the transition to home. A Board Certified Behavior Analyst (BCBA) conducts caregiver interviews, behavioral assessment, functional assessment when indicated, and develops individualized behavior support recommendations. The intervention includes consultation and coaching for hospital staff, caregiver t

Primary outcome measures

• Change in Aberrant Behavior Checklist-Irritability (ABC-I) Score [Time frame: Assessed at baseline (hospital admission), at hospital discharge, and at 2 and 6 weeks post-discharge, assessed up to 365 days.]

Secondary outcome measures (6)

• Clinical Global Impression-Improvement (CGI-I) [Time frame: Assessed at hospital discharge and 2 weeks post-discharge, assessed up to 365 days.]
• Clinical Global Impression-Severity (CGI-S) [Time frame: Assessed at baseline (hospital admission), hospital discharge, and 2 weeks post-discharge, assessed up to 365 days.]
• Hospital Length of Stay, days [Time frame: Day of hospital admission to day of hospital discharge, assessed up to 365 days.]
• Use of Restrictive Interventions [Time frame: Day of hospital admission to day of hospital discharge, assessed up to 365 days.]
• Caregiver Transition Survey [Time frame: Assessed at baseline (hospital admission), hospital discharge, 2 weeks post-discharge, and 6 weeks post-discharge. Assessed up to 365 days.]
• Family Perception of Care Survey Item Ratings [Time frame: Assessed at hospital discharge, 2 weeks post-discharge, and 6 weeks post-discharge. Assessed up to 365 days.]

Eligibility criteria

Inclusion criteria

• Age 12 years or older.
• Established or documented diagnosis of autism spectrum disorder (ASD) in the electronic medical record or confirmed by the attending provider using DSM-5 criteria.
• Admitted to a participating Hackensack Meridian Health hospital due to behavioral concerns (e.g., aggression, self-injury, elopement, or property destruction) that contribute to or prolong hospitalization.
• Behavioral support identified by the attending provider as a primary component of the current admission.
• Caregiver or legally authorized representative (LAR) able to provide informed consent.
• Patient assent obtained when applicable.
• Voluntary, court-mandated, and ward-of-the-state admissions are eligible.

Exclusion criteria

• Admission for an acute medical condition in which behavioral concerns are not a primary driver of hospitalization.
• Medical instability that precludes participation in telehealth sessions.
• Absence of a caregiver or legally authorized representative able to provide informed consent.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 2 centers

• Hackensack Meridian Health Jersey Shore University Medical Center — Neptune City
• Children's Specialized Hospital-Rutgers University Center for Autism Research, Education, — Somerset

Identifiers

NCT: NCT07701915 · TeleABA-WCG-20253445 · 5R44MH134706-03

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗