OPINION: Telehealth Answer to Autistic Keiki in Hawaiʻi Missing Out on Care

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The following is an opinion piece and does not necessarily reflect the views of Big Island Now or Pacific Media Group. It has not been edited for content.

“April just marked Autism Awareness Month, a perfect time to reflect on and assess the needs of those with autism. For individuals and families impacted by the diagnosis, the topic remains important year-round beyond this observance — day in and day out.

Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. According to the Centers for Disease Control and Prevention (CDC), autism affects an estimated 1 in 54 children in the United States.

For children with autism in Hawaiʻi, access to telehealth is a particularly important issue, and not just because of the increase in telehealth services across the country due to the pandemic. Telehealth allows better access for the primary treatment of children with autism, known as applied behavior analysis (ABA). ABA focuses on teaching skills and reducing interfering behaviors as a way to increase levels of independence.


For children in rural areas, or on islands such as Lānaʻi and Molokaʻi, in-person care is generally inaccessible as there are no providers for children with autism on island. And, for most families, traveling daily between islands for care is not feasible. As a result, these families need access to telehealth, but due to bandwidth issues, many locations still cannot receive access. 

This is extremely problematic, as the benefits of ABA treatment through telehealth cannot be underscored enough. As the Director of Clinical Operations for Behavioral Health at BAYADA Home Health Care in Hawaiʻi, I have personally seen how telehealth can positively impact children with autism.

Helping families with challenges to physical access to care is only one of telehealth’s many benefits. It can help provide a more realistic view into the homes and allow clinicians an opportunity to address the concerns parents report for behaviors only seen in the home, versus the differing needs for support in the community.


Furthermore, if a client is engaging in socially challenging behavior, such as disrobing, telehealth can help to maintain client dignity as the provider is not physically present and can give the family some privacy during that moment. Additionally, if parents are struggling with something in real time, such as a new bedtime routine, they have the option of hopping on a telehealth session with the provider that night — this immediate access to care and support would be extremely unlikely without telehealth capabilities. 

On the provider side, avoiding travel time can also allow clinicians to see more families in a day, and thus more children in Hawaiʻi can access treatment for autism. This is particularly important since there is already a shortage of ABA trained professionals in Hawaiʻi, which is why the BAYADA team works to actively recruit and train such individuals.

It is important for the community to come together to support families of children with autism wanting access to medical treatment such as ABA, by advocating for the critical need for access to telehealth services in marginalized, unserved and underserved rural communities.”


-Kristen Koba-Burdt, Director of Clinical Operations for Behavioral Health in Hawaiʻi at BAYADA Home Health Care

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