TeleABA for Hospitalized Adolescents and Young Adults With Autism Spectrum Disorder

N/ANot Yet RecruitingNCT07701915

Caring Technologies, Inc.120 enrolled

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.

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

Standard Hospital CareBEHAVIORAL

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.

Telehealth Applied Behavior Analysis (TeleABA)BEHAVIORAL

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 training, discharge planning, and four weekly telehealth caregiver coaching sessions following hospital discharge to support implementation of behavior support strategies and continuity of care.

Eligibility

Sex: ALLMin age: 12 Years

Medical Language ↔ Plain English

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.

Outcomes

Primary Outcomes

Change in Aberrant Behavior Checklist-Irritability (ABC-I) Score

The Aberrant Behavior Checklist-Irritability Subscale is a caregiver-reported measure of irritability, agitation, aggression, tantrums, and self-injurious behavior. Scores range from 0 to 45, with higher scores indicating greater irritability and more severe behavioral symptoms. The primary outcome is the change from baseline in ABC-I score, comparing participants receiving Hospital TeleABA with those receiving standard care.

Time frame: Assessed at baseline (hospital admission), at hospital discharge, and at 2 and 6 weeks post-discharge, assessed up to 365 days.

Secondary Outcomes

Clinical Global Impression-Improvement (CGI-I)

The Clinical Global Impression-Improvement (CGI-I) is a clinician-rated measure of overall improvement in behavioral symptoms compared with baseline. Scores range from 1 to 7, where 1 = very much improved, 4 = no change, and 7 = very much worse. Lower scores indicate greater clinical improvement. CGI-I scores will be compared between participants receiving Hospital TeleABA and standard care.

Time frame: Assessed at hospital discharge and 2 weeks post-discharge, assessed up to 365 days.

Clinical Global Impression-Severity (CGI-S)

The Clinical Global Impression-Severity (CGI-S) is a clinician-rated measure of the severity of behavioral symptoms at the time of assessment. Scores range from 1 to 7, where 1 = normal, not at all ill and 7 = among the most extremely ill patients. Higher scores indicate greater symptom severity. CGI-S scores will be compared between participants receiving Hospital TeleABA and standard care.

Time frame: Assessed at baseline (hospital admission), hospital discharge, and 2 weeks post-discharge, assessed up to 365 days.

Hospital Length of Stay, days

Hospital length of stay, defined as the number of days from hospital admission to hospital discharge, obtained from the electronic health record.

Time frame: Day of hospital admission to day of hospital discharge, assessed up to 365 days.

Use of Restrictive Interventions

Number of manual or chemical restraint events during hospitalization, extracted from the electronic health record.

Time frame: Day of hospital admission to day of hospital discharge, assessed up to 365 days.

Caregiver Transition Survey

The Caregiver Transition Survey is a caregiver-reported questionnaire assessing caregiver distress, confidence managing behavioral and safety needs, confidence implementing discharge recommendations, and crisis readiness. Each item is rated on a 6-point ordinal scale ranging from 0 (Not at all) to 5 (Extremely). Individual item ratings will be compared between groups.

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

The Family Perception of Care Survey includes caregiver-reported ordinal item ratings of perceived benefit of behavioral consultation, perceived reduction in support needs, perceived safety, and readiness to return home. Individual ordinal survey item ratings will be compared between groups.

Time frame: Assessed at hospital discharge, 2 weeks post-discharge, and 6 weeks post-discharge. Assessed up to 365 days.