Telehealth in school-based practice: Perceived viability to bridge global OT practitioner shortages prior to COVID-19 global health emergency

Abstract

BACKGROUND: Prior to the COVID-19 global health emergency, telehealth was an emerging occupational therapy (OT) service delivery model possessing many positive attributes. These include the potential to offset well-documented global occupational therapy practitioner (OTP) shortages. However, wide-spread adoption of telehealth as a delivery model in school-based practice is lacking in the OT evidence literature. While the COVID-19 global health emergency propelled many OTPs into the use of telehealth technologies, in some cases with minimal preparation, an investigation was conducted into the likelihood of telehealth adoption when comprehensive training was provided so that appropriateness of student fit for telehealth could be determined and essential planning could take place. OBJECTIVE: Prior to the COVID-19 global health emergency, a comprehensive training program was developed incorporating detailed perceptions of OTPs experienced in and new to telehealth in school-based practice as measured via surveys with the goal of increasing adoption of telehealth technologies for the delivery of OT services. Following the completion of the online New to Telehealth Pre-training Survey, OTPs new to telehealth were invited to complete the OT Telehealth Primer: School-based Practice training program. Analysis of pre- and post-training surveys yielded information about attitudinal changes experienced post-training. METHODS: Prior to the COVID-19 global health emergency, school-based occupational therapy practitioners (OTP) experienced in telehealth were invited to complete a survey exploring benefits and barriers encountered in the delivery of OT services using telehealth. OTPs new-to-telehealth were invited to complete a different survey intended to explore attitudes about the potential use of telehealth. Data collected from both surveys were used to develop a comprehensive training program, The OT Telehealth Primer for School-based Practice. OTPs new-to-telehealth were invited to complete the training program and a post-training survey. A descriptive data analysis was completed on responses from pre- to post-training surveys and the chi-square test of independence was used to evaluate difference in reported likelihood of adopting telehealth into practice before and after training. RESULTS: Prior to the COVID-19 global health emergency, the top benefits identified by the OTP Experienced Telehealth-User Survey included: 1) service access, 2) collaboration and carry-over with team members, 3) efficiency themes, and 4) student engagement and comfort. Top benefits identified by the OTP New to Telehealth Survey identified the same top benefits after participating in the training program. A significant decrease in perceived barriers was noted in scores from pre- to post-training by OTPs new to telehealth. The perceived barriers that did not significantly decrease post-training suggest the need for future education and future protocol development. These included: unreliable internet, lack of hands-on opportunity and e-helpers’ (parent, caregiver or support system available to assist the student in person during a telehealth session) decreased comfort with technology. Of the participants who completed the OT Telehealth Primer: School-based Practice, 80% reported being likely to add telehealth as a delivery model for future OT practice. CONCLUSIONS: Prior to the COVID-19 global health emergency, completion of the comprehensive training program OT Telehealth Primer: School-based Practice program yielded improved perceived benefits and an increased likelihood of telehealth adoption into practice by OTPs. However, both OTPs and school administrators require ongoing education for successful widespread adoption to be achieved thus offsetting the global shortage of OTPs and increasing service access. Future research, particularly related to available training and support for the rapid adoption of telehealth technologies during the COVID-19 global health emergency, will yield helpful information about the likelihood of continued use of telehealth in practice.

Working from home during the COVID-19 pandemic: Impact on office worker productivity and work experience

“…Respondents identified if they had adjusted their work schedule due to working at home by selecting either or both: "I now schedule my work hours around others" or "I have adjusted my work hours (ear-lier/later, switched days of week, shorter/longer)." The presence (yes) or absence (no) of other individuals or pets in the home were indicated across the following categories: independent adult (other than respondents themselves), dependent adult (e.g., special needs, geriatric care), teenage child (13-18), school-age child (6)(7)(8)(9)(10)(11)(12), toddler (2)(3)(4)(5), infant (<2 years), pets (e.g., dogs, cats). Respondents indicated ways in which their home workspace was obtained selecting any responses that were true among the following choices: "I purchased new items for myself," "My employer purchased new items for me," "I brought items home from my office," and "I did not get anything new."…”

“…The organization and completion of work have been impacted across nearly all industry sectors, including educational and information services, governments, healthcare and social services and many other professional and business services, raising concerns about the resilience of various parts of our lives to any new rare and extreme event [1]. To enhance their corporate resilience and safeguard the community's health and well-being, organizations that have been hit significantly by the pandemic rapidly embraced the concept of remote working, also known as work from home (WFH) [2,3]. Shifts to WFH due to the pandemic have sparked discussions about the future of office work that can adopt innovative methods, support new practices, and embrace the idea of a virtual workforce [4].…”

Feasibility, Acceptability and Limitations of Speech and Language Telerehabilitation during COVID-19 Lockdown: A Qualitative Research Study on Clinicians’ Perspectives

“…Therefore, it seems extremely important to increase the accessibility of TR through various types of training or courses. Indeed, professional training was shown to have the potential to remove barriers that hinder telehealth implementation [28].…”

Implementation of Telehealth Services in Rural Schools: A Qualitative Assessment

“…While we conducted this study prior to the COVID‐19 pandemic, the pandemic has further highlighted disparities in rural access to care and the increased need for health and mental health services among school‐aged children 27,30‐32 . Early evidence suggests that telehealth is playing an important role in providing continuity of care to children and adolescents, particularly for children with behavioral and mental health concerns and those with special health care needs 33‐35 . The rapid shift toward remote learning, the temporary lifting of many telehealth Medicaid and private insurance reimbursement policy restrictions including expansion of telehealth in school settings, as well as federal CARES Act and other grant programs to improve connectivity and broadband access in rural areas, represent an opportunity for schools to expand telehealth 36‐42 .…”