Society for Developmental & Behavioral Pediatrics Position Statement on Telehealth

Abstract

Telehealth has long held promise as a way to increase access to subspecialty care for children and families, including in developmental and behavioral pediatrics (DBP). The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid uptake of telehealth to continue care delivery that was facilitated by "temporary" policy changes related to the pandemic. As a result, the field of DBP has recognized telehealth as a potential model of care for performing home-based diagnostic assessments, providing medication management follow-up, and delivering therapeutic interventions for children with neurodevelopmental disorders. Telehealth has been helpful in mitigating barriers families often face when attending in-person visits (lack of transportation and child care, missed work hours, etc) but has also highlighted additional determinants of health that need to be addressed to provide equitable access to care (broadband connectivity, device access, digital literacy, access to interpretation and sign language services, etc). Anticipating the lifting of pandemic-related emergency declaration and expiration of temporary policies around telehealth, the ability to continue to deliver DBP care by telehealth is uncertain. The purpose of this policy statement is to advocate for legislation and policies that support ongoing, equitable, home-based telehealth care for patients seen by DBP providers while ensuring equitable access to DBP in general. In addition, there is a need to recognize the benefits and challenges of telehealth versus in-person care and to identify clinical scenarios that favor 1 model of care versus the other.

Challenges to Telehealth

“…These results reinforce the literature that emphasizes the need to increase access to broadband and suitable devices for children with NDD. 15 Further research is needed on the best way to assess the technology needs.…”

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Use images to assist with communication barriers Utilize inclusive intake processes to ask about technology access 21 Consider closed captioning options for persons with hearing impairment Identify community resources that offer free internet access Permit patients to access telehealth from any safe, physical location to decrease barriers to access 15 Provide guidance on telehealth visits at an in-person visit

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“…Permit patients to access telehealth from any safe, physical location to decrease barriers to access 15 …”

“…The Society for Developmental & Behavioral Pediatrics cited improved access, increased naturalistic observations, reduced travel challenges and cost reduction as reasons supporting telehealth. 15 Children with NDD can experience increased stress when in unfamiliar environments. Clinician ability to observe patients in their homes through telehealth offered a different perspective to develop a diagnosis and resulting plan of care.…”

Habilitative Teletherapy for Children with Autism Spectrum Disorder: A Survey of Parents

“…8 There has been a proliferation of research on telehealth as a possible strategy to mitigate in-person service losses for children with autism. [9][10][11] Before the pandemic, feasibility and potential efficacy of telehealth interventions have been demonstrated for individuals with ASD in several systematic reviews. 12,13 A small telehealth occupation-based coaching intervention study conducted before COVID-19 found significant gains in parent efficacy, in various domains of child participation, and in parent-identified goals postintervention.…”