Skip Navigation Links
Skip Navigation Links
April 2021Expand April 2021
January 2021Expand January 2021
November 2020Expand November 2020
July/August 2020Expand July/August 2020
May/June 2020Expand May/June 2020
March/April 2020Expand March/April 2020
January/February 2020Expand January/February 2020
September/October 2019Expand September/October 2019
July/August 2019Expand July/August 2019
May/June 2019Expand May/June 2019
March/April 2019Expand March/April 2019
January/February 2019Expand January/February 2019
November/December 2018Expand November/December 2018
September/October 2018Expand September/October 2018
July/August 2018Expand July/August 2018
May/June 2018Expand May/June 2018
March/April 2018Expand March/April 2018
January/February 2018Expand January/February 2018
November/December 2017Expand November/December 2017
September/October 2017Expand September/October 2017
July/August 2017Expand July/August 2017
May/June 2017Expand May/June 2017
March/April 2017Expand March/April 2017
January/February 2017Expand January/February 2017
November/December 2016Expand November/December 2016
September/October 2016Expand September/October 2016
July/August 2016Expand July/August 2016
May/June 2016Expand May/June 2016
March/April 2016Expand March/April 2016
January/February 2016Expand January/February 2016
November/December 2015Expand November/December 2015
September/October 2015Expand September/October 2015
July/August 2015Expand July/August 2015
May/June 2015Expand May/June 2015
March/April 2015Expand March/April 2015
January/February 2015Expand January/February 2015
ArchiveExpand Archive
Special Edition - EPRExpand Special Edition - EPR
Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 Developing Strategies for Accessing Services Using Telehealth for Children with Special Health Care Needs and Other MCH Populations

Sara Miller
Program Analyst


Imagine living in a rural community where going to the nearest pediatric specialist requires a full day of planning. The logistics involved in setting an appointment with the specialist can be daunting for parents: arranging transportation and allocating money for travel, taking time off from work, taking a child out of school, and speaking with insurance companies to determine which services will be covered and which will be paid out-of-pocket. Telehealth uses technology and partnerships to provide services at a distance, offering greater access to care and more opportunities for those in need of services.

For many families with children with special health care needs, the growing use of telehealth services offers promising solutions. Telehealth offers a variety of modalities such as synchronous or live video, remote patient monitoring, asynchronous or store-and-forward, and mHealth (mobile health) and provides sub-specialty services. At the AMCHP 2018 conference, experts from the Center for Connected Health Policy (Mei Kwong) and the Washington Department of Health(DOH)- (Ellen Silverman, Bradley Klos, and Amy Edmonds) presented on the benefits of telehealth for children with Autism Spectrum Disorder and other developmental disabilities (ASD/DD). Telehealth is conducive to Autism treatment because of its tiered-delivery model, which involves in-person treatment planning and monitoring, synchronous and asynchronous telehealth sessions, and parent training on ASD/DD intervention techniques.  In addition to treatment for ASD/DD, successful telehealth programs exist in psychiatry, neonatology, maternal depression prevention, nutrition, and endocrinology.

The Washington DOH team has integrated state systems of care for children and youth with ASD/DD, with an emphasis on medically underserved populations. A focus for the project is strengthening the state's telehealth infrastructure to increase access to services in rural and other medically underserved communities. The Washington DOH has undertaken research approaches to determine the effectiveness of telehealth services for this population, including key informant interviews, an online provider assessment, an online family survey, and in-depth family interviews. Results demonstrated that telehealth offers less disruption of daily schedules, cost-effectiveness, increased access to pediatric specialists and less stress for children and caregivers. Access to specialists and cost-effectiveness is a result of state and federal telehealth policies.

Telehealth offers benefits and opportunities, but like many health care services, it is not a one-size-fits-all solution, and many factors impact its success.  Uptake of various telehealth modalities, including live video, store-and-forward (asynchronous), remote patient monitoring and hub-and-spoke (one main provider is the hub and branches out to other organizations), may show success or failure depending on state regulations, geography and other factors. Investment in telehealth infrastructure, including satellite offices and equipment; professional development, greater collaboration among health care providers, and parent education are opportunities for growing and strengthening telehealth functionality and usage.

Mei Kwong from the Center for Connected Health Policy spoke of the complexity and diversity of telehealth federal and state regulations.  45 states have a "telemedicine" definition, 34 states and the District of Columbia have a "telehealth" definition and one state, Alabama, did not have a definition for either. At the federal level, there are telehealth regulations regarding geography, providers and services. Medicare will reimburse physicians, nurse practitioners, physician assistant, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetists, clinical psychologists and registered dieticians. For Medicaid, telehealth policies on services and reimbursement vary by state. For the advancement of telehealth, billing and reimbursement, HIPAA regulations and safety issues remain challenging.  But telehealth is a promising means of increasing access to care for MCH populations.