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Context and issues: The introduction of individualised funding under the National Disability Insurance Scheme in Australia aimed to increase individual choice and control over how people received disability supports. An increase in the allied health disability workforce was anticipated; however, disability workforce sector reports have consistently indicated difficulties in attracting and retaining sufficient allied health staff to satisfy current and future demand. Autism spectrum disorder is the most prevalent primary diagnosis of participants receiving individualised funding to date and requires support staff to have specialised skills and experience. Given that overall staff attraction and retention issues are reported to be exacerbated in regional and remote areas of Australia, it is important to seek innovative ways of supporting individuals on the autism spectrum in their local communities. Technology has the potential to provide a timely and low-cost alternative that extends access to specialist services for people in remote locations. The current project aimed to identify the feasibility, essential requirements and potential barriers in delivering therapy support to regional and remote participants on the autism spectrum via video-conferencing technology. Lessons learned: A multidisciplinary team (speech pathologist, occupational therapist, psychologist and a special educator) were recruited and trained to deliver tele-therapy services to 16 participants on the autism spectrum, in collaboration with their families and local support teams. Participants resided in two northern, nine western and one southern regional area in New South Wales (NSW), Australia. There were three sets of siblings. One participant resided on remote Lord Howe Island off the coast of northern NSW. Researchers used semi-structured telephone interviews to gain insight into the program from key stakeholder groups including parents, education staff, allied health professionals and tele-therapists. A general inductive approach to data analysis was used under five project evaluation areas. The evaluation focused on five areas including: development of the tele-health delivery team, understanding the role of collaboration, examining the need for autism-specific support, establishing the need for in-person contact and identifying barriers to success. The project evaluation found that investment in staff training and support was key to building a competent tele-therapy team and delivering successful tele-therapy services under a sustainable model. For many families and support team members, collaboration was reported as an important part of the tele-therapy program, with families and teachers finding it helpful to work together with the same information. The evaluation confirmed that access to autism-specific knowledge and support was novel and regarded as beneficial for families and support teams living in regional and remote areas. There were mixed responses to the inclusion of in-person support as part of a tele-therapy service. While some families felt a tele-therapy service was no different to in-person services, other families and tele-therapists indicated that the addition of at least one in-person session would help to increase rapport. Barriers within the tele-therapy model included scheduling and local staff changes, as well as the delivery of intervention requiring physical support. Technology was not seen as a barrier in the current study. This research adds to the growing body of information supporting the use of tele-practice for geographically isolated regions. Ideally, tele-therapy should not replace in-person services; however, it is necessary when no other comparable service option is available locally. Larger scale research is needed to compare blended, online and in-person models so that an optimal ratio can be established.

Objectives It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle. Technology provides a possible solution not only for increasing access to these opportunities, but also in building community capacity to support children with autism. The aim of the present study was to investigate the current learning and support needs within rural and remote professionals prior to setting up a model of support. Methods An online survey was used to gather information from service providers in rural and remote communities on their demographics, current skills and confidence in working with clients on the autism spectrum, current supervision and professional development, identified learning and support needs, and the availability and uptake of technology for accessing professional development. Results Respondents reported below average levels of perceived confidence and skills when working with children with autism, most notably children with challenging behaviour. Half the respondents do not currently attend supervision sessions, with only 15% receiving regular supervision (fortnightly or more often), and 66% of respondents had travelled more than 3h to access professional development workshops. The majority of participants had access to technology and over half had already used this for online training. Conclusion Overall, service providers in rural and remote areas are generally not currently meeting their needs in terms of frequency of supervision and professional development. The present needs analysis identifies key areas for learning, the ideal frequency of support and the acceptability of using technology to deliver this support. This information will guide future researchers in the development of an evidence-based model that will be accessible and meaningful to its participants. What is known about the topic? It is known that there are difficulties in recruiting and retaining practitioners in rural and remote communities and that access to support and professional development can be key in breaking this cycle, which may be triggered by geographical isolation. Technology-delivered intervention and support, also known as eHealth or Telehealth, has been used successfully in the disability sector for medical rehabilitation, direct intervention, employment support and support groups, but there is little evidence as to how technology is received by and implemented with disability and mainstream service providers supporting children with autism living in remote regions. What does this paper add? This paper provides an insight into the current skills and confidence of a broad range of service providers, including educators, allied health therapists and therapy and community support workers, in working with children with autism. This paper also investigates the experience, feasibility and potential uptake of a technology-driven program of support and professional development in rural and remote Australia. Finally, this paper provides an insight into the desired frequency of training and support, as well as identified learning support needs. What are the implications for practitioners? These findings have and will continue to guide practitioners in the development of an evidence-based, technology-driven model of supporting rural and remote staff working with children with autism. Technology has the potential to provide practitioners in geographically isolated areas with access to more responsive, collaborative and individualised professional support and training. Such practice may improve the skills of practitioners and the level of support they can provide their clients with autism, with the added potential of increasing staff retention in rural and remote areas of Australia.