When the Bay Rivers Telehealth Alliance (BRTA) was created about seventeen years ago, there was a pioneering spirit among the member healthcare providers serving Virginia’s Middle Peninsula and Northern Neck. At the time, the promise of telemedicine helping expand access to care and reducing health disparities was still more aspirational than practical. After all, there were logistical and technological hurdles still to address, and questions remained as to how enthusiastic providers and patients would take to this still emerging platform.
But BRTA members rolled up their sleeves and soon found traction with the region’s hospital systems and residents of this largely rural part of the state. Even before the pandemic, telehealth appointments began to grow, and as local communities began warming to the idea of connecting with their physicians via the internet, BRTA began exploring new opportunities, especially in areas of critical need.
Like schools.
School-Based Telehealth Programs
Five years ago, using grant money, BRTA initiated school-based health services focused on improving students’ access to care, including critically important behavioral health services. While demand for behavioral healthcare always has been a vital resource for children throughout their school years, when the pandemic crashed like a wrecking ball through the normal rhythms of academic life, the need for mental health services expanded exponentially.
“When COVID-19 happened, the utilization of behavioral telehealth with schoolchildren just skyrocketed,” says Donna Dittman Hale, BRTA’s executive director. “Kids are in trouble. Coming back to school is highly stressful, and among the highly stressed kids there is a small subgroup that is really hurting.”
Hale estimates that perhaps a dozen families were taking advantage of behavioral telehealth services prior to the pandemic, but then COVID-19 flipped the proverbial switch, and suddenly more than 180 families – a fifteen-fold increase – were logging on to telehealth services through BRTA’s partnership with schools in five area counties. And services were especially utilized by Black and Hispanic families, Hale notes.
This surge in the use of behavioral telehealth services was made possible by BRTA’s provider, the Middle Peninsula Northern Neck Community Services Board, who at the start of the pandemic, pivoted very quickly to train their entire staff to deliver services via telehealth with competency and compassion.
“The isolation that we as adults felt during COVID-19 is magnified for a child when they don’t have those coping techniques that we as healthy adults might have,” Hale says. “Then there’s the increased exposure to the negative effects of social media, the negative effects of peer pressure and bullying – all of these factors contribute to the demand for behavioral health services.”
Young generations are well-equipped to use technology
As Hale and her team worked with school administrators in working out the technological aspects necessary for scaling up, something else was happening with its school partners. Skeptics in the use of telehealth – unsure that telehealth services could work with elementary school children, for example – became believers.
“They realized that this next generation of children are very used to that – their tablets, their devices,” says Hale. “Several of the school systems allow children to use inter-school tablets for telehealth, and so now they [the former skeptics] are right up there among the advocates saying, ‘sure, we can do crisis intervention work with schools and children.’”
The spike in demand has exacerbated budget constraints, and Hale has been appealing to local schools and other funders to help share the funding burden; otherwise, there’s risk in cutting back the program or even discontinuing it. Ironically, while BRTA received a $900,000 grant from the federal government to help establish a sister telehealth alliance on Virginia’s Eastern Shore, finding the funding for its own school-based behavioral health services remains a challenge, especially as kids go back to school, and the assumption is that the telehealth component is not now as critical. And staffing – administrators and direct staff alike – within the schools and behavioral health providers also has been a persistent challenge.
As we emerge from the other side of COVID-19, those on the front lines of delivering telemedicine services are facing an overarching challenge: can the progress that so many communities have made in creating reliable, accessible and efficient telehealth services be sustained?