Take Up and Implementation of School-Based Telehealth in Tennessee

• In Event: Mental Health in Education: Risks, Interventions, and Access to Care

Abstract

Many children live in areas with limited access to physical and mental health care. School-Based Health Centers directly address disparities by providing medical services on site, which may reduce barriers including time, transportation, and costs. Efforts to expand SBHCs have been particularly prevalent in areas where students lack access to other health services including Title 1 schools and rural areas. However, since SBHCs rely on partnerships with external medical providers, limited local health staffing capacity can also pose a challenge for establishing in-person SBHCs. Telehealth offers a potential remedy by connecting schools with distant medical providers.

There has been a rapid rise in use of telehealth for physical and mental health appointments within SBHCs, with 76% of surveyed SBMHs reporting some telehealth use in 2022 (Soleimanpour et al., 2023) versus just 20% in 2017 (Love et al., 2019). Key school conditions facilitate program implementation including a site-based program champion, dedicated school-based staff to serve as telepresenters, technology and training in its use, integration of telehealth services with broader SBH initiatives and staff responsibilities (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. And, there have been no claims-level analysis of school-based telehealth usage among Medicaid-enrolled children.

This mixed-methods study brings together medical claims data and interviews with school staff in order to understand the take-up and implementation of school-based telehealth in Tennessee. First, I draw on a state-wide longitudinal health and education data assembled through a partnership between Vanderbilt University and its medical center, the Tennessee Education Research Alliance, and the Tennessee Departments of Education, Health, and Medicaid. These data include medical claims for all Medicaid-enrolled, school-aged and administrative records for all students in public schools from the 2013-2014 through 2022-2023 school years. Next, I analyze interview data from Coordinated School Health Directors in 84 of the 147 total public-school districts. I examine districts’ rationales for adopting school-based telehealth, the types of programs they support, and the organizational resources which influence districts’ capacity to implement school-based telehealth.

Forty-five districts in our interview sample currently or had previously used telehealth to provide physical or mental health services. However, utilization of these services was low among students and school staff struggled to integrate telehealth into their day-to-day routines. As a result, telehealth technology often sat unused. Similarly, I see low levels utilization in Medicaid data, with only 9,497 school-based telehealth claims from 2013 through 2023, 63% of which were for speech-related therapies. Schools with higher utilization had proactively invested in designated in-person staff to serve as telepresenters, rearranged school space to promote privacy for telehealth sessions, and partnered with external medical providers who facilitated timely appointments through telehealth-specific clinicians. Overall, these results challenge the idea that school-based telehealth is a replacement for in-person staffing. In contrast, substantial investment in school-based staff and routines is needed to realize the benefits of a telehealth program.

Author

• Sara White, Vanderbilt University
  Presenting Author