COVID-19 Concerns Add Value to School-Based Telehealth Programs

School may not be in session because of the coronavirus pandemic, but that doesn’t mean school-based telehealth programs are shuttered. In many cases, they’re busier than ever.

While originally designed to treat non-acute health concerns and keep students in school, connected health platforms have evolved to handle a variety of issues, including chronic care management and behavioral health concerns. Those concerns haven’t gone away during the COVID-19 emergency, and are often exacerbated because students are stuck at home, with perhaps even less access to healthcare than at school.

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In Massachusetts, a telemental health program run through Athol Hospital for students in two high schools pivoted to a home-based program in mid-March, when the schools closed. Maureen Donovan, the hospital’s program manager, said counselors had to transition from seeing students via telehealth in a room at school to connecting wherever and whenever a student could find the time and space at home to talk.

“Now that we’re at home, we’ve seen things that we’ve never seen before,” Donovan said during a recent virtual session hosted by the Northeast Regional Telehealth Resource Center and Mid-Atlantic Telehealth Resource Center.

Donovan said the program – based in rural region of the Bay State – had to find ways to ensure access for students who didn’t have access to telemedicine technology or broadband at home. In addition, counselors often had to deal with a noisy home environment that often intruded on a student’s privacy.

“We’re trying - we’re trying to have family support and sibling support,” she said, noting students would sometimes call in from their car or another remote location, or text-message or e-mail counselors to keep the lines of communication going.

“They’re all doing what they need to do to have sessions,” she said.

Donovan expects that the program, currently serving more than 100 students, will remain home-based if and when schools reopen this fall. She said school districts will place a heavy emphasis on academic activities during whatever becomes of the school day, to make up for time lost to the pandemic, and programs like the telemental health platform will need to work around the edges.

“School is going to be very different,” she said, and a telemedicine platform “will allow us to be flexible” in meeting student needs.

In some areas, particularly rural and underserved regions, the school nurse may be a student’s only access to healthcare. School districts have often partnered with local health systems to make sure primary care needs were being met.

When these schools shifted from in-person education to virtual education, they had to make sure their healthcare services were virtual as well.

“A lot of folks don’t realize that school nurses are still working full time,” says Josh Golomb, CEO for Hazel Health, a national provider of telehealth services for schools. “What those nurses quickly asked us to do is offer Hazel at home. Students still need healthcare.”

Robert Darzynkiewicz, Hazel’s chief medical officer, points out that the COVID-19 crisis not only sent students home from school – it closed or severely limited access to primary care providers. Parents stopped going to the doctor’s office with their children.

With that in mind, school districts, local health systems and providers like Hazel Health worked to emphasize telehealth as an option. They pushed services out to the home not as a means of replacing what was lost when schools closed, but to make sure people were able to access care.

Golomb, noting his business has increased significantly over the past two months, says school districts are now learning the value of a telehealth platform.

“This has heightened the realization that they need to be offering more services,” he says. “The simple part of healthcare is what we actually see during the school day … but there’s a lot more” that goes into a school health program.

With re-opening on the horizon, Golomb and Darzynkiewicz say school districts are now scrambling to prepare for what will be a much different environment – and they’re peppering healthcare providers with questions about how to set things up. How should schools handle COVID-19 testing for both staff and students, and what do they do when someone tests positive? And how will traditional healthcare services still be made available?

Like Donovan, Golomb says school districts will rely more heavily on telehealth platforms that can offer services at home – particularly services like chronic care management and behavioral health. They’re looking at more wrap-around services, he says, that complement the academic program while offering better and more convenient access to care.

“Our goal is to be where the kids are,” Darzynkiewicz says.

In colleges and universities, the telehealth platform is just as important, if not more so. Campus health centers are, in many cases, the sole source of healthcare for students during the school year. And being stuck at home doesn’t make things any easier.

“There’s a strong need for psychiatric services and counseling no matter where they are,” says Anne Fisher, a clinical psychiatrist and head of the wellness center at the New College of Florida, which “went from 100 percent in-person to 100 percent online” in March.

Fisher says students face a wide variety of behavioral health concerns and stresses in a college setting, ranging from sex and gender identity issues to the challenges of coping with classes and social life away from home. Those issues are still there even when the student is home, and they can’t walk over to the health center to chat with a counselor.

“This is a crucial time in their life,” she says, noting that her center sees roughly 40 percent of the college’s 800-student population. One moment they’re living on or near the campus, she says, “and the next moment they’re back at home. Suddenly they’re a kid in the house again.”

Fisher says her department’s telemental health platform, developed in a partnership with Mantra Health, is more important now than ever, but the challenges are daunting. Privacy and security issues abound with virtual care, and there’s the added difficulty of making sure that out-of-state students can access the service.

“These things get trickier when you’re remote,” she says.

As well, while the school will re-open, perhaps this fall, the campus will be decidedly different. COVID-19 protocols will affect how many students live in a dorm, how meals are delivered, even how students interact with elderly faculty and staff who are more susceptible to the virus. Older buildings will have to be thoroughly cleaned, maybe even reconfigured.

“Generally, counseling centers are stuck wherever they can be stuck,” Fisher says. “Old offices in older buildings, or converted spaces with poor ventilation.”

With an emphasis on healthcare, or healthier activities, that will change. And in an effort to reduce the need for major construction and renovation projects, as many programs as possible will be transitioned to telemedicine platforms, giving providers and students more freedom to connect when and where they can find the time and space. As well, there will be more emphasis on pushing resources out to students through virtual platforms, including mHealth apps.

“I think this is going to change (campus) healthcare a lot … especially mental healthcare,” she says.