Moving Forward

As students return to school buildings, many are looking at how in-person care can be supplemented by telehealth

Moving Forward

The benefits of telehealth are evident: adolescents have greater access to services when they do not face transportation barriers and can have common SHS needs addressed virtually. These visits offer convenience as they can occur anywhere that provides privacy and a stable internet connection, and can allow adolescents to speak with a trusted provider through a secure portal.

Many physicians using telehealth expect to continue to use it significantly more than before the pandemic, and we likely will also see an increase in the number of adolescents needing SHS as the COVID-19 emergency has prevented them from accessing necessary care. As adolescents return to school buildings and in-office visits are expanded, the field should explore the continued use of telehealth as a supplement to in-person care. Hybrid models can allow providers to administer care that requires hands-on interactions in-person and use telehealth for SHS they can complete virtually.

How clinicians can connect adolescents to the necessary care should also be explored. Those in need of SHS may initially access care for a different reason (i.e., sports physicals, mental health appointments, routine vaccinations, etc.). Providers can evaluate if telehealth services would be appropriate. Providers must be comfortable recognizing and screening for SHS needs of adolescents, regardless of stated visit type.

Telehealth offers a unique opportunity for expanded care through SBHCs as adolescents already spend much of their time in schools and may have greater access to SHS in that setting or through a referral system.  Community clinics can partner with school health providers to increase adolescent access to services.  This can look like creating a private space in the school with the appropriate devices that allows adolescents to have virtual appointments right in the school setting.   School health providers will need to plan school-wide outreach efforts as adolescents return to school buildings and can work with outside providers in these efforts. Well-planned outreach will allow staff to reconnect with returning adolescents while getting to know new students and introduce them to the SHS available to them.

To support continued access to telehealth, providers will need continued guidance around payment, privacy and confidentiality, and regulatory changes. These policies should consider telehealth as an essential path to increasing access to SHS for adolescents in marginalized groups, universal reimbursement and coverage of telehealth services, and preventative technology, including vaccines. These policies will likely vary by jurisdiction, so state or local level policymakers can take the lead on implementing changes to make SHS access easier for adolescents.

Continued development of best practice strategies and additional research are necessary to guide the continued use of telehealth services. Using lessons learned from the COVID-19 pandemic will be valuable in informing SBHC and community clinics on how best to take advantage of telehealth in continuing to meet the sexual health needs of adolescents and ensure their overall wellbeing.

Resources

The Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents outlines considerations for adolescent health visits, including confidentiality, that providers can translate to the virtual space.  Many of these considerations can apply to visits for SHS. See a preview of this resource here.

In August 2020, the Northeast Telehealth Resource Center published a roadmap and toolkit for implementing primary care and behavioral health services during the COVID-19 pandemic. This comprehensive tool begins with steps to evaluate the needs and feasibility of telehealth implementation. It takes users through implementing a care services plan, risk analysis, and cost and billing considerations.  Access the roadmap here.  Also in 2020, the American Medical Association (AMA) published a comprehensive Telehealth Implementation Playbook, which includes 12 detailed steps from identifying a need for telehealth and forming a team to evaluation and scaling of telehealth programs.

Voices for Georgia’s Children published an April 2020 report on school-based telehealth implementation with a specific focus on navigating common challenges to increase access to care. The report identified the main obstacles to school-based telehealth implementation: a lack of stakeholder understanding of telehealth and buy-in, difficulty engaging and sustaining relationships with health care providers or specialists, low program enrollment, and lack of adequate personnel to implement and manage the program. The report further explores identified challenges and offers solutions, workarounds, and best practices.

In April 2020, CDC published a Dear Colleague Letter outlining specific clinical recommendations and guidance on providing effective STD care and prevention when facility-based services and in-person patient-clinician contact is limited.  In December 2020, CDC published an updated Treatment Guidelines for Gonococcal Infection, recommending a single 500 mg intramuscular dose of ceftriaxone for uncomplicated gonorrhea. Providers should administer treatment for coinfection with chlamydia with oral doxycycline (100 mg twice daily for seven days) when they cannot exclude a chlamydial infection. A May 2020 Dear Colleague Letter clarified Expedited Partner Therapy (EPT) vis-a-vis limited patient-clinician contact.

In response to the COVID-19 pandemic, some states, such as Mississippi, extended school-based emergency telehealth coverage which made it possible for schools without school nurses or school-based clinics to access telehealth services.  Read about the extension here.  Medicaid Reimbursement for telemedicine services for children are made at the state level.  A summary of states’ reimbursement policies can be found here.