Inspiration

OpenABA was developed to support behavioral health professionals deliver therapy remotely and intuitively to their patients remotely and while socially distanced.

Preliminaries

Applied behavior analysis (ABA) is the leading discipline among therapies for childhood autism. As the most data- and research-driven form of therapy for autism, its popularity has grown steadily and is widely used by both care-provider agencies and special educations programs in schools. Tooling in this space has been limited and at the beginning of the COVID pandemic, best practices shared in professional forums often pointed to Zoom screenshares of Microsoft Paint windows, which suffered from latency and responsiveness issues between the therapist and client.

ABA sessions typically consist of a variety of activities designed to develop verbal and reasoning skills, and are guided via a trained therapist. Trained providers are usually either a registered behavior technician (RBT), or a board-certified behavior analyst (BCBA). The provider(s) plans activities (also called "targets"), evaluates client responses (the “behavior” in Applied Behavior Analysis), and delivers intermittent rewards (called "reinforcers").

Controls on tooling in this increasingly specialized field vary by payer and state: though some states and insurance companies have relaxed requirements on diligence on HIPAA compliance, many states still have strict HIPAA-alignment on tools enabling services via telelealth, requiring a business associate agreement (BAA) between providers seeking reimbursement and said provider's software vendors.

What it does

OpenABA allows therapists to deliver services to their clients remotely. In particular, we provide tools to providers for realtime interaction in specially designed activities, activity design and creation, gamification customization (according to the learning plan designed for the child), low-latency, private videochat, and report generation.

OpenABA is also a solution that enables social distancing for clients who require in-person sessions. With the remote control function, therapists can present therapy through two devices such that the client receives instruction through an iPad or computer that is controlled through the therapists phone or another device.

How I built it

OpenABA is built with Next.js and a GraphQL API gateway in the backend. Supporting services include a WebRTC messaging service, STUN and TURN servers, and a media integration with Google Drive.

Challenges I ran into

Our biggest challenge was meeting HIPAA compliance with our realtime features and providing guarantees thereof in a BAA. We achieved this in mid-August, and have since been serving American school districts.

Accomplishments that I'm proud of

We're proudest of the work we do for our users, one of which described OpenABA as "the best software I have used in my career".

ABA professionals from the Philippines and Ireland have sought access (for whom we specially expanded our SMS authentication reach). Beyond the coronavirus pandemic, we are hoping to catalyze the adoption of OpenABA as a means for therapists to serve people in need in remote locations.

As of the writing of this README, what started with three posts on a beta supporting 40-some users from the Telehealth in ABA Facebook forum has grown to over 550 users 100% organically, and special educators and private therapists both have reached out for assistance in adoption into their HIPAA-compliant workflows.

What I learned

Content-wise, our learnings were largely in the variety of activities ABA professionals use with their clients as we fine-tuned our product to simplify and specialize with delivering ABA services. Technically, our gained experience in improving WebRTC videochat capabilities via STUN- and TURN- servers.

What's next for OpenABA

Since launch, over a dozen users across four countries have reached out to volunteer with OpenABA in educational and research capacities.

We are building organizational support so that OpenABA can serve users who require HIPAA-aligned business associate agreements covering PHI.

The team is currently exploring a number of avenues to sustain development, including accelerators, non-profit fundraising, and possible integration into Linux Foundation’s newly-formed Public Health division.

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