Poster #32 - Do We have the Capacity? Examining the Potential of School-Based Telehealth

• In Event: Friday Poster Reception

Abstract

Many children live in areas with limited access to pediatricians and receive minimal preventative care (Drescher & Domingue, 2023; Irwin et. al., 2009). Efforts to expand School-Based Health Centers (SBHCs) have been particularly prevalent in areas where students lack access to other health services (Soleimanpour et. al., 2023). However, since SBHCs rely on partnerships with external medical providers, limited local health staffing capacity can also pose a challenge for establishing in-person school-based health services (Gamm et. al., 2010; Shelton & Owens, 2020). Telehealth offers a potential remedy by connecting schools with distant medical providers, thus expanding SBHC staffing capacity. 

There has been a rapid rise in use of telehealth within SBHCs, with 20% of surveyed SBHCs reporting some telehealth use in 2016-2017 (Love et. al., 2019) versus 76% in 2022 (Soleimanpour et. al., 2023). School-based telehealth services can include psychiatric evaluation and ongoing mental health therapy (Carmine, 2024; Sowa et. al. 2024), urgent-care sick visit diagnosis and prescription (Mackert & Whitten, 2007; Mayfield et. al., 2023), and appointments with specialists to support the management of chronic health conditions such as asthma and diabetes (Garber et. al., 2021; Izquierdo et. al., 2009). Implementing telehealth programs requires local resources including a site-based program champion and dedicated school-based staff to serve as telepresenters, technology and training in use (Pradhan et. al., 2019; Fox et. al., 2022; Mackert & Whitten, 2007). However, prior studies have not explored the extent to which these enabling conditions exist or can be built within districts with high student health needs. 

This study explores the adoption and implementation of school-based telehealth with Tennessee. Recent hospital closures and elimination of specialized services have left some TN residents with limited local access to health care (Branam et. al., 2022; Goodwin, 2024). At the same time, the Tennessee Department of Education has encouraged districts to expand their physical and mental health supports (TDOE, 2021). Within this context, I ask:

1. 
   

   How does school-based telehealth influence the capacity of school districts in Tennessee to address children’s mental and physical health needs?

   
   


2. 
   

    How do the existing organizational capacities of school districts in Tennessee influence the adoption and implementation of school-based telehealth initiatives?

   
   

I utilize a mixed-methods approach drawing on state-wide medicaid and education data in combination with 85 semi-structured interviews with coordinated school health directors. To address RQ1, I describe rates of telehealth utilization for mental health appointments across the state. I then use an event-study approach to estimate changes in student health outcomes in years after the opening of a SBHC with telehealth services compared to trends in districts with in-person only SBHCs and no SBHCs. For RQ2, I utilize an abductive approach to qualitative analysis of district staff interviews. My coding is informed by Spillane et. al. (2012)’s conceptualization of the role of resources in education policy implementation, with the goal of understanding the specific mechanisms by which districts’ organizational contexts influence the provision of telehealth. 

Author

• Sara White, Vanderbilt University
  Presenting Author