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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.

In 2012, 15.8% of rural school-based health centers were using telehealth technology. 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
  • Dental examinations
  • 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

School-based telehealth programs use hub-and-spoke models, implement store-and-forward technology, and use real-time telemedicine. In the hub-and-spoke model, schools can serve as spoke sites or hub sites. When serving as a spoke site, schools establish a clinical station, located in an office or other type of room, with appropriate telehealth technology. When serving as a hub site, schools establish a receiving station equipped with technology such as a camera, computer, and monitor. Store-and-forward technology can be used in schools to transmit health information for services such as dermatology, pathology, radiology, and some acute care. Real-time telemedicine includes e-consultation, direct patient interaction, and group discussions.

Live-video conferencing is the most common mode of telehealth delivery in pediatric care, according to data from a provider survey assessing how telehealth is used to provide healthcare services to children with special healthcare needs in California. Videoconferencing is also commonly used to deliver school-based telehealth services. Other telehealth tools used for children include computers, cell phones, and other devices. 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.

Telehealth has also been used to provide remote patient monitoring and access to subspecialty care for babies. For example, through a partnership between the Childress Regional Medical Center and Children's Medical Center Dallas in Texas, the hospital provides remote monitoring and consultation with neonatologists and other subspecialty physicians using telehealth.

Oral health and dental care is another area for which rural communities are using telehealth to increase access to care among children. For example, technology such as a digital camera or an intraoral camera can be used by a healthcare professional to conduct dental screenings. Hygienists can also share dental information, such as X-rays, intraoral photos, and other data, electronically with dentists at a remote site. Some rural communities have established telehealth dental clinics in schools, community centers, and other public facilities.

Examples of Rural 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.
  • Capitol Dental Care is a school-based virtual dental home in Polk County, Oregon. The program provides oral health services, including dental exams, routine cleanings, X-rays, and fluoride varnishes. The program established an oral health services integration team, consisting of dental assistants and expanded practice dental hygienists, that delivers routine dental visits. Using a store-and-forward model, the team securely shares photographs and radiographs with offsite dentists. Offsite dentists can then develop treatment plans and determine next steps.
  • Children's Mercy Kansas City operates four telemedicine clinics that provide allergy, asthma, and immunology services. The clinics use a remote presence solution (RPS) with a high-resolution camera and a digital stethoscope and otoscope. The program reduces the need for residents of rural counties in Kansas and Missouri to drive to see a specialist.
  • The Family Advocacy Network (FAN) is a program to address child abuse cases that serves 14 rural counties in Nebraska. Telemedicine technology is used to connect victims of abuse with trained mental health professionals.
  • 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 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 School-based Consultations for Rural Pediatric Telehealth (SCRiPT) Network uses telehealth to increase access to specialty care — include 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 University of California (UC) Davis is using telemedicine to implement 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.

Implementation Considerations

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 as a hub or spoke site 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 health providers in the community, including primary care practitioners or pediatricians. Care coordination could require additional investments in staffing or health information technology infrastructure that allow 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. Additional implementation considerations including licensing and reimbursement are discussed in Module 4: Implementation and Module 6: Sustainability.

Program Clearinghouse Examples

Resources to Learn More

Realizing the Promise of Telehealth for Children with Special Health Care Needs
Document
Describes the use of telehealth to provide healthcare services to children with special healthcare needs living in rural California. Shares opportunities, barriers, and recommendations for the adoption of telehealth and provides program examples.
Author(s): Vigil, J., Kattlove, J., Litman, R., Marcin, J., Calouro, C., & Kwong, M.W.
Organization(s): The Children's Partnership
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
Describes effective telehealth programs that have been implemented in schools and childcare centers and their impact on improving access to healthcare for children. Outlines a guide to establishing a school or childcare center telehealth program.
Organization(s): The Children's Partnership
Date: 8/2018

School-Based Telehealth: An Innovative Approach to Meet the Health Care Needs of California's Children
Document
Describes the healthcare needs of children living in California. Covers the benefits of school-based telehealth programs for addressing children's healthcare needs and lessons learned from existing school-based telehealth programs. Offers recommendations for using telehealth to meet children's needs.
Organization(s): The Children's Partnership
Date: 10/2009

Using Telehealth to Improve Maternal and Child Health Outcomes in Georgia
Document
Describes telehealth programs implemented in Georgia working to increase access to healthcare services among children. Describes collaborations with existing programs to expand the use of telehealth, such as Women, Infant, and Children Nutrition Program, Children's Medical Services Program, and high-risk obstetrics clinics. Covers telehealth program results, lessons learned, and next steps.
Organization(s): Association of State and Territorial Health Officials
Date: 4/2018