Pediatric neuropsychological evaluation via telehealth: Novel models of care

Abstract

Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program. Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscoveringtypes of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models. Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.

Transitioning to telehealth neuropsychology service: Considerations across adult and pediatric care settings

“…Institutions must consider cultural and health disparities, as the majority of the population can access electronic devices, but the assumption that everyone owns a device that is adequate for telehealth is false. For example, an emailed survey to parents of scheduled or waitlisted pediatric neuropsychology patients (N ¼ 222, 26% response rate) suggested that although 94% of respondents were interested in a telehealth appointment, only 74% of those owned either a desktop or laptop computer with a camera (Pritchard et al, 2020). The ability to reach a larger and more remote patient population is possible with teleNP; however, as clinicians and researchers begin to explore the opportunities this technology offers, its limitations must be identified and respected.…”

“…Thus, a clinical interview and review of records can serve as an intervention in itself but can also be useful in accurately triaging testing cases. Practice models for triage and decision-making are described elsewhere in this issue (Hewitt & Loring, 2020;Pritchard et al, 2020).…”

“…For example, a caregiver could be asked to open a mailed envelope with rating scales and give the measures to the child to complete during the session. For certain pediatric patients, particularly those who need substantial behavioral support, the neuropsychologist may choose to obtain the vast majority of relevant assessment data via diagnostic interviewing of the parent/caregiver, record review, and administration of parent rating scales (i.e., Tier 1 services; Pritchard et al, 2020), minimizing or omitting performance-based measures entirely. Likewise, given the limitations of using teleNP for children, the APA has also reinforced the importance of behavioral observations, the clinical interview, and review of records, noting that these data acquisition methods can help to support test results obtained via telehealth (APA, 2020b).…”

A case series illustrating the implementation of a novel tele-neuropsychology service model during COVID-19 for children with complex medical and neurodevelopmental conditions: A companion to Pritchard et al., 2020

“…As pediatric neuropsychologists at an academic medical center, we are concerned with how to best serve our medically and neurodevelopmentally complex patients during this unprecedented time. While our colleagues (Pritchard et al, 2020; this issue) present a novel three-tiered pediatric tele-neuropsychology service model, applying this modelfor complex medical and neurodevelopmental patients requires that clinicians engage in careful clinical decision-making. Thus, the current manuscript serves as a companion to Pritchard et al (2020) and illustrates the practical application of the model through clinical cases.…”

“…While our colleagues (Pritchard et al, 2020; this issue) present a novel three-tiered pediatric tele-neuropsychology service model, applying this modelfor complex medical and neurodevelopmental patients requires that clinicians engage in careful clinical decision-making. Thus, the current manuscript serves as a companion to Pritchard et al (2020) and illustrates the practical application of the model through clinical cases. In the case presentations below, we identify specific service options and service decision points within the model.…”