PROJECT SUMMARY There is an increasing trend for children with ASD with primary behavioral challenges to be hospitalized in medical facilities because accessible behavioral support resources are not available in local communities. Unfortunately, most community-based hospitals are not well equipped to meet optimal behavioral care with families consequently experiencing prolonged/protracted hospitalizations where behaviors may not be adequately treated and could potentially worsen. Further, the specific inability to adequately respond to challenging behaviors may limit the ability of children to be accepted into step-down facilities or return home safely and contribute to extremely stressful aspects of care. Prolonged hospitalizations also result in significant negative financial return for hospitals (un/under-reimbursement). In prior work, deploying a specialized brief Applied Behavioral Analysis (ABA) assessment and intervention explicitly designed for use during hospitalizations demonstrated improvements in challenging behaviors, decreases in restraint and staffing, and high levels of family satisfaction. Unfortunately, community access to this type of intervention is extremely limited by geographic location and provider availability. Appropriate telehealth and digital health systems that can facilitate tele-mediated support may hold great potential for increasing the availability of such care to children, families, and the providers and hospitals responsible for their care. While many technologies for real- time video conferencing are available (e.g. zoom), in order to be able to accurately support understanding of precursors and the context of key behaviors technologies capable of supporting intelligent surveillance, data- flagging, and efficient communication of key behaviors across human support teams (both expert and non- expert) over substantial periods of time (including when experts are not present) are needed to enable meaningful telemediated ABA service. The current project creates and tests the potential clinical value of an innovative telehealth platform to facilitate appropriate, efficacious ABA tele-assessment and intervention for adolescents with ASD displaying challenging behaviors during hospitalizations and post-discharge transition. In the first phase of this work, we propose co-design of the novel system with key stakeholders and feasibility testing to demonstrate both technical capacity and potential clinical value. In the second phase of this work, we hone the systems commercial value and conduct a rigorous trial to demonstrate clinical utility and financial return for children, families, systems of care, and payers.

PROJECT NARRATIVE There is an increasing trend (a) for children with autism spectrum disorder (ASD) with primary behavioral challenges to be hospitalized in medical facilities because accessible behavioral support resources are not available in local communities and (b) for these hospitalizations to be extremely challenging for children, families, providers, and systems of care (i.e. prolonged hospitalizations; challenges with discharge to step- down facilities; use of restraint, sedation, etc.; high-levels of staffing; un/unreimbursed care for hospitals). Appropriate telehealth and digital health systems that can facilitate tele-mediated behavioral support during hospitalization and through discharge transition may hold great potential for increasing the availability of such care to children, families, and the providers and hospitals responsible for their care. The current project creates and tests the potential clinical value of an innovative telehealth platform to facilitate appropriate, efficacious ABA tele-assessment and intervention for adolescents with ASD displaying challenging behaviors during hospitalizations and post-discharge transition which could powerfully enhance care systems for individuals with ASD and severe challenging behavior that may require intensive support at times in low resource settings.