Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment

Abstract

BACKGROUND In rural areas with health professional workforce shortages, telehealth offers an opportunity to address service gaps and meet the health needs of students. Few studies have examined telehealth implementation in rural schools. This study explores facilitators and barriers to the implementation of telehealth programs in rural schools and identifies strategies for successful implementation to inform future school‐based telehealth initiatives. METHODS We conducted semi‐structured qualitative interviews with 50 key informants involved in the implementation of telehealth programs funded through the School‐Based Telehealth Network Grant Program. Researchers completed a thematic analysis of interview transcripts. RESULTS The most commonly cited barriers were technology, reimbursement for services, and facilitating acceptance of the telehealth among school staff, clinicians, parents, and students. Key informants identified strategies for facilitating program implementation, including technology training and support, marketing efforts, and integration into existing school processes. CONCLUSIONS School‐based telehealth can augment clinical capacity in areas with clinician shortages. Entities interested in such an approach to care must engage with their school community to ensure successful implementation. For rural, school‐based telehealth to gain greater adoption and be sustained, these services must be reimbursable by Medicaid and private insurers.

Interpersonal Connections Are Important for Virtual Kidney Transplant Educational Program Development

“…20,21 Many studies have qualitatively assessed the implementation of telehealth programs in a variety of settings and found that successful implementation required the collaborative support of key stakeholders in the community, clinical, and policy sectors. 13,22 Additionally, other studies have highlighted the importance of relationship-building when implementing telehealth programs. 23 In the current study, research participants were concerned with the provision of a space that preserved the ability to form relationships and sustain interpersonal connections, all things that could be considered easier to achieve in an in-person setting.…”

Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre‐ and Early Stages of the COVID‐19 Public Health Emergency

“…8 Prior to COVID-19, school representatives identified having schoolbased telehealth reimbursed by Medicaid and private insurance was imperative to the sustainability of the programs. 36 However, it is important to note ongoing challenges and barriers, such as limited access to broadband and remote care resources (including support and clinical staff), that can impact telehealth capabilities in rural school communities. In a 2017 survey of SBHCs, only 10% were utilizing telehealth, 37 which may be reflective of these challenges or indicative of apprehension in the delivery, coordination, or utilization of virtual care.…”

“…Likewise, 85% of parents who started telebehavioral health services for their child during the pandemic plan to continue telehealth sessions in the future 8 . Prior to COVID‐19, school representatives identified having school‐based telehealth reimbursed by Medicaid and private insurance was imperative to the sustainability of the programs 36 . However, it is important to note ongoing challenges and barriers, such as limited access to broadband and remote care resources (including support and clinical staff), that can impact telehealth capabilities in rural school communities.…”

“…In a 2017 survey of SBHCs, only 10% were utilizing telehealth, 37 which may be reflective of these challenges or indicative of apprehension in the delivery, coordination, or utilization of virtual care. Implementation can be facilitated by technology training and support, having champions at all levels to promote the process, ongoing communication and awareness of the services, and by staying flexible and adaptive to student needs 36 . As new challenges arise related to individual and familial behavioral health needs amidst the COVID‐19 PHE and in future circumstances, establishment, or expansion of school‐based telebehavioral health services should be strongly considered in school settings.…”

Leveraging community health workers in extending pediatric telebehavioral health care in rural communities: Evaluation design and methods.

“…The workforce training uses a telementoring model called Project Extension for Community Health care Outcomes (ECHO), which utilizes case-based and didactic interactive learning to create a learning community and enhance self-efficacy in implementing evidence-based interventions (Chicoine et al, 2021). Our program and others have enhanced youth’s access to behavioral health through school partnerships (Fox et al, 2022; Nelson & Patton, 2016). Driven by community-identified needs and priorities, THR recognizes the need to address social services and behavioral health needs concurrently to maximize positive impact on students, families, schools, and communities.…”