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Implementation Considerations for Telehealth Programs Serving Children

Rural program planners seeking to implement telehealth services for children in schools should be aware of regulations that protect student health records. In traditional school-based health centers, healthcare staff follow confidentiality guidelines for student health records established by the Family Educational Rights and Privacy Act (FERPA). However, school-based telehealth programs that bring in outside staff and healthcare providers typically follow confidentiality guidelines for student health records established by HIPAA. The U.S. Department of Health and Human Services and the U.S. Department of Education have released joint guidance to help school officials and healthcare professionals navigate the application of FERPA and HIPAA to student health records. The National Association of School Nurses also offers resources to help schools understand HIPAA and FERPA privacy rules.

School-based health centers typically require parents or legal representatives to sign consent forms allowing children to be treated via telehealth. Rural telehealth programs should also be aware of regulations that grant minors the right to consent to medical treatment and services without parental permission. The age at which a minor can consent to treatment may differ depending on the medical condition. For example, within states, the age of consent for treatment for outpatient mental and behavioral health may differ from the age of consent for treatment of sexually transmitted infections. For mHealth models, rural telehealth programs should be aware that the terms of service in some applications may require all users to be over the age of 18, even if state laws allow minors to consent to treatment. Rural telehealth programs may consider reaching out to the mHealth vendor to seek an exception for their program.

Resources to Learn More

Clinical Update: Telepsychiatry With Children and Adolescents
Document
Reviews the pediatric telepsychiatry evidence base. Describes best practices for delivering telepsychiatry to children and adolescents and updates to procedures for conducting telepsychiatry services.
Citation: Journal of the American Academy of Child and Adolescent Psychiatry, 56(10), 875–893.
Date: 10/2017

Operating Procedures for Pediatric Telehealth
Document
Provides guidance to healthcare providers delivering telehealth services to children and young adults. Covers patient privacy and confidentiality, patient safety, and legal regulatory considerations.
Organization(s): American Telemedicine Association
Date: 4/2017

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

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, Infants, 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