Telehealth Models for Increasing Access to Care Among Children

This model includes strategies for using telehealth to increase access to care among children. Telehealth is beneficial for children and their families because it expands and enables access to healthcare services that may otherwise be unavailable, such as mental healthcare services and specialty care. Telehealth programs are also beneficial for children because they reduce the burden of travel for families and address workforce shortages that are common barriers to accessing care in rural communities.

Rural schools are applying technology to improve access to both primary care and specialty care, manage chronic health conditions, address complex healthcare needs, support children with developmental and behavioral conditions, and deliver health education to children. Examples of healthcare services provided in school-based telehealth programs include:

• Primary care
• Acute and sub-specialty care
• Childhood hearing screenings
• Speech therapy
• Mental health/psychiatric services
• Behavioral health services
• Chronic disease management
• Asthma testing and management services
• Diabetes monitoring
• Care coordination
• Health education
• Oral health and dental care

The Health Resources and Services Administration offers a comprehensive best practice guide for telehealth for school-based services. The guide includes considerations for designing a program, billing, and offering appointments for behavioral health and diabetes, among other topics.

Examples of Rural Telehealth Programs for Children

• Telehealth has been applied to assist with care coordination among children with special healthcare needs, increase access to pediatric subspecialist care, and provide remote patient monitoring for chronic conditions. For example, the Children's Medical Services program, operated by the Georgia Department of Public Health (GDPH), coordinates pediatric specialty clinics for children living in rural counties across the state. These clinics use telehealth and telemedicine, such as audio and visual equipment, to provide the following specialty care services: cardiac, developmental, endocrinology, genetic, nephrology, neurology, neurosurgery, pediatric surgery, pulmonology, scoliosis, and sickle cell.
• The University of Kansas Medical Center's Telehealth ROCKS program offers a range of telebehavioral health services to rural children and their families. Providers from University of Kansas connect with children and their families through live-video telehealth at schools and primary care practices, including community health centers. Telebehavioral services include parenting programs, therapy, medication management, behavior analysis, and assessments, including autism assessments and psychological evaluations. In addition, Telehealth ROCKS is using Project ECHO to build the capacity of rural providers, school personnel, and other child-serving systems to manage behavioral health conditions among children.
• The University of California (UC) Davis is using telemedicine for the School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services (STARS) program in underserved communities. The program uses virtual visit technology to provide telerehabilitation services to children with disabilities such as cerebral palsy, spina bifida, and spinal cord injuries.

Examples of Rural School-Based Telehealth Programs for Children

• The Bleckley County Board of Education, through the South Georgia Regional Prevention Coalition, is using telehealth to expand access to primary and specialty care services, including behavioral health and oral health, within 17 school-based health centers (SBHCs) in four public school systems.
• Health-e-Schools is a program providing healthcare services to children in schools in rural, western North Carolina. The program addresses common rural barriers to accessing care, including geography and provider shortages. Providers use video teleconference and special portable equipment that nurses can carry with them between schools.
• The School-based Consultations for Rural Pediatric Telehealth (SCRiPT) Network uses telehealth to increase access to specialty care — including behavioral healthcare — at rural school-based health centers across the country. The SCRiPT Network facilitates treatment recommendations and referrals through telehealth, as well as training for school-based health center staff.
• The My Virtual Clinic School-Based Telehealth Program offers school-based telehealth services in rural Linton, Indiana. A school nurse triages patients and determines whether a telehealth visit is needed. The program connects participating schools with local Greene County General Hospital Rural Health Clinic sites. The school nurse collects samples if necessary and conducts tests for the remote provider using equipment connected to the telehealth system, such as a stethoscope.

Implementation Considerations

Rural communities should be aware that Medicaid reimbursement for certain services varies from state to state.

Rural communities seeking to implement or expand telehealth programs to increase access to care among children must consider a variety of factors. School-based telehealth programs must have school staff designated for administering and/or facilitating the telehealth services. Some important considerations for organizing telehealth sessions include:

• Selecting a room that offers privacy, comfort, and connections for hardware and internet
• Ensuring good lighting for videoconferences
• Providing appropriate audio equipment, such as a microphone and/or headphone
• Ensuring that the camera position is fixed and steady
• Providing adequate seating for all participants

While school-based telehealth programs provide important support to manage the health issues of children and their families, school staff may lack the time and resources to fully manage chronic health conditions. Rural school-based telehealth programs may need to explore options of coordinating care with relevant healthcare providers in the community, including primary care practitioners or pediatricians. Care coordination could require additional investments in staffing and health information technology infrastructure that allows for secure transmission of patient information.

Another important consideration is ensuring that families are aware of available telehealth services. Families frequently learn about telehealth from their providers. Telehealth programs may be able to serve more children if families are informed that telehealth is an option for receiving services.

The Rural Services Integration Toolkit provides additional implementation considerations for school-based health services. Implementation Considerations for Telehealth Programs Serving Children, in Module 4, addresses issues relate to privacy and consent. Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Funding & Sustainability.

Program Clearinghouse Examples

• Community Health Center, Inc./Weitzman Institute
• University of Kansas Medical Center

Resources to Learn More

COVID-19 Frequently Asked Questions (FAQs) for State Medicaid and Children's Health Insurance Program (CHIP) Agencies
Document
Provides answers to FAQs for state agencies about regulatory changes to Medicaid and CHIP programs that arose in response to the COVID-19 pandemic.
Organization(s): Centers for Medicare & Medicaid Services (CMS)
Date: 1/2021

Realizing the Promise of Telehealth for Children with Special Health Care Needs
Document
Reports on the use of telehealth to improve access and coordination for specialized healthcare services needed by children with special health needs, who live in areas where providers may be scarce. Discusses opportunities and barriers to a broader adoption of telehealth, and offers recommendations to address challenges and advocate for adoption of telehealth as an option for care.
Author(s): Vigil, J., Kattlove, J., Litman, R., et al.
Organization(s): The Children's Partnership (TCP)
Date: 8/2015

Roadmap for Action: Advancing the Adoption of Telehealth in Child Care Centers and Schools to Promote Children's Health and Well Being
Document
A guide to help promote the adoption of telehealth implementation policies in school and child care settings by offering strategies for overcoming barriers, identifying opportunities supporting adoption, and providing tools for development. Topics include: selecting partners, gathering data to assess needs, obtaining equipment, privacy concerns, payment options, and measuring outcomes.
Organization(s): The Children's Partnership (TCP)
Date: 8/2018

Telemedicine in School-based Health Centers: A Profile of the Center for Rural Health Innovation
Document
A case study featuring school-based health centers participating in the Center for Rural Health Innovation's Health-e-Schools (telemedicine) program, which serves schools in rural North Carolina.
Organization(s): American Public Health Association (APHA)
Date: 2/2018