By Diane Behl
National Center for Hearing Assessment and Management
Those working within the maternal and child health system are familiar with the challenges faced by families in accessing needed specialized services. This reality is particularly frustrating when paired with our knowledge that optimal outcomes for children with special needs depends on access to high quality, specialized early intervention services. For example, families of children who are deaf or hard of hearing (DHH) who require very specialized interventionists trained in the child's communication mode are often only found in urban settings.
Thanks to rapidly improving video technology, receiving such specialized services is possible – even when there are no providers in the community. Tele-intervention (TI), the delivery of early intervention services via telehealth technology, has the potential to ensure children and families receive the needed intensity of services in a cost-effective manner.
To foster the use of TI, the National Center for Hearing Assessment and Management (NCHAM) – a HRSA-funded national technical resource center to support EHDI systems – created the "Tele-intervention Resource Guide" for implementing TI. This Web-based guide features information on equipment selection, how to conduct a TI session, as well as licensure and security considerations.
A tele-intervention session is conducted much like an in-person visit, with an emphasis on putting the family "in the driver's seat," reinforcing the role of families as partners in decision making. The principles of embedding intervention into every-day routines and coaching the family to reinforce their role as their child's primary teacher are key, encouraging the implementation of best practices in early intervention.
There is additional evidence to support the use of TI. Kelso, Fiechtl, Olsen, and Rule (2009) provided multidisciplinary early intervention services using telehealth technologies and demonstrated savings of time and resources associated with the delivery model. More recently, a comparison group design study conducted by NCHAM and partners demonstrated that the TI group scored statistically significantly higher on the expressive language measure than the in-person group (p =.03), and parent engagement also was better.1 Cost savings associated with providing services via TI increased as the intensity of service delivery increased.
Tele-intervention is occurring or planned in roughly 30 percent of states, according to a survey conducted with state Part C Early Intervention Coordinators.2 Its broader adoption is constrained by several challenges.3 Many policymakers and early intervention administrators are skeptical that family-centered services can be provided through a computer. Licensure regulations require that most therapists be licensed in the state where their clients live, which can be costly. Privacy and security requirements under the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) also are often identified by administrators as reasons for avoiding TI implementation, even though practical strategies exist to address these issues. Then there are the very real challenges with bandwidth limitations and the cost of high-quality connectivity, particularly in rural areas.
As distance communication technologies continue to develop, maternal and child health stakeholders need to investigate new ways of reaching families, especially those that are cost effective. Tele-intervention is no panacea, but it is an important strategy in ensuring access to high-quality, family-centered services. In turn, families need to speak up about what works best for them – what truly fits within their family lifestyle and strengthens their ability to support their child's ability to develop optimally. It just might be through tele-intervention.
1 Blaiser, K., Behl, D., Callow-Heusser, C., & White, K. (2013). Measuring Costs and Outcomes of Tele-Intervention When Serving Families of Children who are Deaf/Hard-of-Hearing. International Journal Of Telerehabilitation, 5(2), 3-10. doi: http://dx.doi.org/10.5195/ijt.2013.6129.
2 Cason, Behl, D., & Ringwalt, S. (2012). Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services. International Journal of Telerehabilitation, 5(2), 39-45. doi:http://dx.doi.org/10.5195/ijt.2012.6105.
3 Kelso, G., Fiechtl, B., Olsen, S., & Rule, S. (2009). The feasibility of virtual home visits to provide early intervention: A pilot study. Infants & Young Children, 22, 332-340.