During the pandemic, Children’s National Hospital in Washington, DC, developed an in-school telehealth program to connect students with a Children’s National doctor when needed while keeping them in school. Shireen Atabaki, MD, MPH, medical director of telemedicine for the hospital’s emergency medicine team, recently spoke with Healthcare innovation about the program’s impact on students’ physical and mental health and plans for future expansion.
Healthcare Innovation: How long has Children’s National been working with district schools on telehealth? Did it start during the pandemic?
Atabaki: We started the program during the pandemic. Just before the pandemic, the District had submitted a request for proposals for telemedicine in DC public schools and public charter schools. We responded to that RFP and received a four-year grant to establish telemedicine in all of the District’s public schools and a percentage of the District’s public charter schools.
HCI: Was there already a need for this type of service before the pandemic emerged?
Atabaki: Yes absolutely. Schools have school nurses, but it is important to have a doctor or licensed independent practitioner available for more comprehensive medical care, especially in the district’s most underserved wards, where children do not necessarily have all the resources for comprehensive, specialized care. what do you need. It also allows families to save time outside of work. Many working families truly rely on their wages or hourly wages for income and cannot afford to miss a day of work. So it’s been very helpful. And for children with chronic illnesses and those who require subspecialty care, it’s also been very helpful to connect them to those services much more quickly.
HCI: Children’s National partnered with telehealth provider Amwell on this project. Had you previously worked with that company on other initiatives?
Atabaki: Yes. We also worked with them on the FCC-funded Connected Care pilot program. We chose them over several vendors simply because of all the capabilities they had, including integration with our electronic health record. That FCC grant was to provide connected care services for underserved children and families in the region through telehealth. It includes things like smartphones and unlimited data plans for underserved families. It allowed for some other services: some maternal fetal health, as well as the Amwell platform for underserved patients and families.
For the school program, we have devices in all schools. That includes a digital stethoscope, an otoscope, and something called a dermatoscope, so you can perform a complete exam: listen to the child’s heart and lungs remotely and look in the ears to diagnose things like otitis media, look in the throat to diagnose sore throat. .
HCI: Does that require any additional training for school nurses?
Atabaki: He does it. We had a very solid training program. We were able to train 100% of the school nurses on the use of those devices before implementing the program. We had a first pilot year in which we did many telephone consultations and we relied on our suppliers. We then began to build the program, starting with 12 schools in our first year in the District’s most underserved districts, and then growing to the current 178, including all DC public schools and several DC public charter schools.
HCI: You mentioned grant funding. Is there a way for the program to be sustainable long term and for Children’s National to get reimbursed through insurance or would you need an expanded grant for it to continue and expand?
Atabaki: At this stage, especially as we focus on underserved children and families, we need grants and some type of collaboration. We are always looking for additional funds. We are expanding into the realm of telepsychiatry and behavioral telehealth, which is a much-needed service. There is a huge need and shortage of services. Unfortunately, it can take up to one or two years to obtain mental health services, especially for children.
HCI: Is the process of a mental health visit very different from that of a physical health visit?
Atabaki: Both require consent. And the mental health visit requires some additional testing that is a little more intense and/or extensive. There are more issues around privacy and we have to make sure the child is in a safe space. There are certain conditions in the District and several other states where the mature adolescent can actually seek care and receive it confidentially; These include substance abuse and some mental health problems.
HCI: In this model, is the telehealth visit always performed by a Children’s National physician or is it outsourced?
Atabaki: Our model is always a Children’s National supplier. Our strength is our specialized services and the experience and national reputation of our suppliers. They are involved in many important clinical trials. They set national standards and write textbooks, so you really get the best of the best subspecialty or specialty professors. During the school day, on weekdays, we are able to turn to our own primary care providers, and many of them also have experience and interests in child advocacy.
HCI: Are there next steps or aspects of the initiative that need to be refined in the future?
Atabaki: Absolutely. Expand the telepsychiatry program, as well as subspecialty care for diabetes and increase asthma care, in addition to helping patients with seizure disorders and patients with complex chronic diseases. All of that was in our original proposal and unfortunately, due to some funding issues, we weren’t able to provide it all initially. We are seeking funding to expand our telebehavioral health program. I think that will be very important for the children and youth of the District and will really change the outcomes for youth. We have seen a tenfold increase in presentations of suicidal children to emergency departments in the United States over the past 15 years. That’s very dramatic. We really want to look at ways forward to prevent and reduce this. I think school telepsychiatry and behavioral telehealth are an important place to start recognizing mental health issues and making early interventions before things get out of control.
