Overview of States' Use of Telehealth for the Delivery of Early Intervention (IDEA Part C) Services

Abstract

Background:Early intervention (EI) services are designed to promote the development of skills and enhance the quality of life of infants and toddlers who have been identified as having a disability or developmental delay, enhance capacity of families to care for their child with special needs, reduce future educational costs, and promote independent living (NECTAC, 2011). EI services are regulated by Part C of the Individuals with Disabilities Education Improvement Act (IDEA); however, personnel shortages, particularly in rural areas, limit access for children who qualify. Telehealth is an emerging delivery model demonstrating potential to deliver EI services effectively and efficiently, thereby improving access and ameliorating the impact of provider shortages in underserved areas. The use of a telehealth delivery model facilitates inter-disciplinary collaboration, coordinated care, and consultation with specialists not available within a local community.Method:A survey sent by the National Early Childhood Technical Assistance Center (NECTAC) to IDEA Part C coordinators assessed their utilization of telehealth within states’ IDEA Part C programs. Reimbursement for provider type and services and barriers to implement a telehealth service delivery model were identified.Results:Representatives from 26 states and one jurisdiction responded to the NECTAC telehealth survey. Of these, 30% (n=9) indicated that they are either currently using telehealth as an adjunct service delivery model (n=6) or plan to incorporate telehealth within the next 1–2 years (n=3). Identified telehealth providers included developmental specialists, teachers of the Deaf/Hard of Hearing (DHH), speech-language pathologists, occupational therapists, physical therapists, behavior specialists, audiologists, and interpreters. Reimbursement was variable and included use of IDEA Part C funding, Medicaid, and private insurance. Expressed barriers and concerns for the implementation of telehealth as a delivery model within Part C programming included security issues (40%; n=11); privacy issues (44%; n=12); concerns about quality of services delivered via telehealth (40%; n=11); and lack of evidence to support the effectiveness of a telehealth service delivery model within IDEA Part C programming (3%; n=1). Reimbursement policy and billing processes and technology infrastructure were also identified as barriers impacting the implementation of telehealth programming.Conclusions:Provider shortages impact the quantity and quality of services available for children with disabilities and developmental delay, particularly in rural areas. While many states are incorporating telehealth within their Early Intervention (IDEA Part C) services in order to improve access and overcome personnel shortages, barriers persist. Policy development, education of stakeholders, research, utilization of secure and private delivery platforms, and advocacy may facilitate more widespread adoption of telehealth within IDEA Part C programs across the country.

Parental perceptions of information needs and service provision for children with developmental disabilities in rural Australia

“…In a recent study of occupational therapists in rural NSW, while the therapists used digital technology for their personal networks and professional development, there was limited use of technology for therapy provision. The reported barriers related to age and technology preferences of the provider, but equally important were issues of limited internet connectivity, training and support as well perceptions about lack of acceptance by clients [53]. As digital technology becomes more accessible both in relation to bandwidth and accessibility through the major telecommunication reform under the aegis of the national broadband network (NBN) program, this barrier is likely to become less of an impediment for service provision both by providers and end-users in rural Australia.…”

“…A study by Tindall and Huebner [51] looked at speech therapy delivered by videophones and found that this method alleviated some of the burden of providing care, and produced similar results to face to face consultations. However, the use of digital technology is still limited by educational barriers and socioeconomic status [52,53]. In a recent study of occupational therapists in rural NSW, while the therapists used digital technology for their personal networks and professional development, there was limited use of technology for therapy provision.…”

Behavioral Telehealth Consultation with Families of Children with Autism Spectrum Disorder

“…In rural communities, children with developmental disabilities often lack appropriate services and supports or are underserved (Cason, Behl, & Ringwalt, ; Hebbeler, Spiker, & Kahn, ; Koegel et al, ; Terry, ; Wacker et al, ). Children with developmental disabilities who engage in serious challenging behavior and reside in rural communities may be at a double disadvantage.…”

Profound Hearing Loss: Addressing Barriers to Hearing Healthcare

“…61 Postimplantation therapies like parent training, auditory training, speech and language therapy, counseling, and communication strategy training have been successfully implemented in rural areas of Australia, but telerehabilitation carries risks associated with confidentiality and security, and concerns about quality and demonstrated effectiveness of services, reimbursement, and maintaining technology infrastructure. 62 Early intervention typically is provided in the home or at daycare. Providing home-based services to older children and adults might increase enrollment and compliance with treatments and reduce travel costs by patients.…”