Children with Special Health Care Needs (CSHCN) represents one out of every seven children in California or about 1.4 million children. CSHCN are children who have, or are at risk for chronic physical developmental, behavioral, or emotional conditions, and who require health and related services beyond that typically required by children.
The report “Realizing the Promise of Telehealth for Children with Special Health Care Needs” (August 2015) was prepared by the Lucile Packard Foundation for Children’s Health with support from The Children’s Partnership www.children’spartnership.org, UC Davis School of Medicine www.ucdmc.ucdavis.edu/medschool, and the Center for Connected Health Policy http://cchpca.org.
The report was prepared in response to online surveys and interviews with key stakeholders and the report discusses how the State of California is addressing the needs of CSHCN and can best utilize telehealth.
In California, CSHCN often require multiple specialists and related services on an ongoing basis from a multidisciplinary set of providers. In addition, these children often receive care from multiple sources such as schools, hospitals, government agencies, and community-based organizations, and therefore require a high level of care coordination which one-half of CSHCNs do not receive.
Some of the State’s current telehealth programs to help children include:
- The California Tele-Audiology Program (CTP) established by the University of California, Davis provides remote diagnostic audiology evaluations for infants who do not pass their newborn hearing screening. Using video conferencing, a pediatric audiologist performs evaluations while the infant remains in their home community
- In partnership with a Los Angeles area medical center, the organization Connecting to Care supports a local clinic to provide video conferencing to connect with pediatric psychiatrists for high risk children with autism spectrum disorder, bipolar disorder, seizure disorders, and other special healthcare needs
- A randomized controlled trial called the Propeller mobile respiratory management platform works with patients using sensor-equipped inhalers. Adult and children are able to track inhaler use and data from sensors, which is than synced to the patient’s smartphone. The data accessed by patients is also transmitted to a server allowing real-time monitoring by physicians
Although there are successful telehealth programs for CSHCN, a number of recommendations are included in the report to help more children, their providers, and their families:
- Providers need to receive comprehensive telehealth information. The California Children’s Services (CCS) program should continue to clarify consolidate, and centralize information on telehealth for providers and conduct outreach to inform providers of their policies
- Efforts need to be made to educate families about telehealth as an option for care. CCS should partner with community-based providers and family advocates who work with families of CSHCN on a daily basis to provide information to families regarding telehealth
- Expand the list of eligible billing codes for telehealth. Many Medi-Cal codes associated with clinical services are not eligible for reimbursement if the service is delivered using telehealth
- Expand eligible locations to include the patient’s home. Because of the complex medical needs of CSHCN, home-based care is particularly critical
- Convene a telehealth stakeholder workgroup to serve as a forum to identify policy barriers and pursue solutions to provide a wider adoption of telehealth for CCS enrolled children
- Implement local demonstration projects to identify best practices on using telehealth to improve care for children enrolled in CCS. The State CCS program should work with county CCS programs and stakeholders to identify lessons, best practices, and then explore ways to make such applications of telehealth scalable
Go to http://lpfch-cshcn.org/publications/research-reports/realizing-the-promise-of-telehealth to view the report.