By Brittany Frew, MPH, Program Manager, Clinical and Community Collaboration, and Sabra Anckner, RN, MSN, Associate Director, Clinical and Community Collaboration, Association of Maternal & Child Health Programs (AMCHP)
During the first several weeks and months of the pandemic, most of our lives were turned upside down. We adapted how we learned, worked, and lived. After years of only sporadic use of telehealth in maternal and child health (MCH) programs, agencies, clinicians, and families were forced to make a switch, almost overnight.
At its worse, telehealth can exacerbate and reinforce inequitable access to care and systemic racism. However, with intentional decision-making and collaboration with families and communities, telehealth can support MCH agencies’ work to increase equity, engage families, and improve outcomes.
AMCHP had the honor of working with agencies in 24 jurisdictions across the country on telehealth projects as part of our CARES Act award from the Health Resources and Services Administration’s Maternal and Child Health Bureau. Although some of the work wrapped up as in-person care resumed, many programs recognized the long-term potential in continuing telehealth services. The evidence base for telehealth in MCH programs is still developing. AMCHP’s Innovation Hub now includes seven cutting-edge telehealth practices that emerged from the CARES Act funding.
How MCH Programs, Partners, and Families Benefit from Ongoing Telehealth Services in Two States and One Territory
Some regions of Utah are very remote, with limited access to health care. Historically, Utah’s Integrated Services Program (ISP), which provides pediatric specialty care as part of its Title V/Children and Youth with Special Health Care Needs (CYSHCN) efforts, traveled staff and clinicians to these sites several times a year to evaluate and monitor children with special health care needs. This meant that many families had to wait months to be seen after a referral, and the travel was expensive and time-consuming for the health care team. With CARES Act funding, ISP created a lending library of laptops and mobile hot spots for families to use to meet with providers virtually. The laptops are kept at local health clinics and can be checked out by families or used onsite. This program has decreased wait times, introduced more flexibility into scheduling, and created significant cost savings for the state, while reducing travel. Some of those funds are being redirected into ongoing maintenance of the lending library.
Before the pandemic, infants living in Cape Cod and on the islands of Martha’s Vineyard and Nantucket who referred for follow-up after their newborn hearing screening were “lost to follow-up” at a higher rate than infants in any other region of Massachusetts. Several factors may account for this difference. First, transportation to diagnostic centers is challenging and may require a ferry ride. In addition, year-round residents of these communities are racially and socioeconomically diverse and often employed in the hospitality and tourism industries with low wages and demanding schedules. To address this gap, the Massachusetts Department of Health partnered with Cape Cod Healthcare and Boston Children’s Hospital to implement diagnostic teleaudiology services using the hub and spoke model. Instead of losing the better part of a day to travel to a Boston Children’s Hospital diagnostic center, families can receive diagnostic auditory brainstem response (ABR) evaluations for their infant nearby. Doing so has reduced the travel burden to families and reduced the time between screening and diagnosis and early intervention services. Moreover, it has also improved follow-up rates.
American Samoa maintained a border closure for nearly two years. While the territory remained free of COVID-19 until 2022, the border closure exacerbated existing shortages of health care personnel including mental health professionals. The MCH team identified a critical need for mental health services among adolescents and viewed telehealth as an opportunity to address it. Through their CARES Act project, the team created and equipped a private, safe space for virtual mental health care visits in each of the 14 high schools in the territory. There, students can connect both to local providers at community-based organizations as well as with Samoan health care providers based in Hawaii. Thus, students can receive care in either English or Samoan and work with providers with a cultural connection. As the project moves toward full utilization, the MCH team hopes to expand by adding telehealth sites at elementary schools, churches, and community centers.
We encourage you to explore AMCHP’s resource library to access some of the resources created by CARES Act awardees, as well as our guidance on equity in telehealth policy. If you have questions about telehealth, please email us at email@example.com.