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
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.
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
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
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.
- 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.
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.
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: Funding & Sustainability.
Program Clearinghouse Examples
Resources to Learn More
the Promise of Telehealth for Children with Special Health Care Needs
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,
Organization(s): The Children's Partnership
for Action: Advancing the Adoption of Telehealth in Child Care Centers and Schools to Promote
Children's Health and Well Being
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
Telehealth: An Innovative Approach to Meet the Health Care Needs of California's
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
Organization(s): The Children's Partnership
Telehealth to Improve Maternal and Child Health Outcomes in Georgia
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