Telehealth value and future considerations in pediatric occupational therapy practice to support innovation and healthcare equity

Telehealth value and future considerations in pediatric occupational therapy practice to support innovation and healthcare equity

by: Elizabeth Morejon, OTD, OTR/L, CSIPT,  and Evelyn Terrell, OTD, MS/HAS, OT/L

The COVID-19 pandemic has transformed our healthcare delivery system and the practice of occupational therapy (OT) across settings. During this pandemic, practitioners have shifted many of their services to a virtual environment to ensure continuity of care for their clients and optimized use of telehealth in the delivery of rehabilitation services within early intervention, school-based practice and other settings. The American Occupational Therapy Association (2018) defines telehealth as “the application of evaluative, consultative, preventative and therapeutic services delivered through information and communication technology.” The purpose of this article is to review the value and current evidence of telehealth with a particular focus on pediatrics. A secondary aim is a call to action to consider future research opportunities, strategies to mitigate healthcare inequities, and a focus on advocacy to support telehealth sustainability and expansion.

Value of Telehealth in OT Practice

Telehealth allows practitioners to deliver services to children and adolescents in the natural environment and creates opportunities for coaching and consultation with parents, teachers, and other professionals in the home, daycare, schools and other settings. Studies have shown the value of telehealth in OT practice and indicated positive outcomes of interventions. These studies suggest clients and providers experience high satisfaction with telehealth, higher than in-person care (Bican et al., 2021; Krasovsky et al., 2021; Shah & Badaway, 2021) and results show telehealth can be a cost effective method to deliver care (Logracre et al., 2020). 

Telehealth is an effective service delivery model for caregiver-coaching to decrease geographic barriers to care, expand the practitioner’s footprint and reach underserved populations facing workforce shortage of professionals (Franz et. al., 2022). Best practices in early intervention show parent coaching supports improvement in parent satisfaction, child performance, and caregiver identified goals, as well as increase ease to integrate treatments within the child’s natural environment (Kronberg et al., 2021; Wallisch et al., 2019). Provision of telehealth services can be achieved successfully through occupation-based coaching and research suggests an increase in parenting efficacy and child participation, in addition to gains in parent identified goals (Little et al., 2018). 

Fischbach (2019) suggests OT services using a telehealth model in school-based practice are considered equivalent to in-person care. Telehealth helps establish strong collaborative working relationships between the family and the OT practitioner. This partnership facilitates family engagement in schools, supports social-emotional development, and promotes student academic success. Fostering family engagement is a responsibility of school-based OTs and is mandated by the Every Student Succeeds Act (ESSA) (Fabrizi & Morejon, 2019; U.S. Department of Education, 2015). Transportation and other barriers can reduce collaboration with families during school-based services, however telehealth offers a possible solution to bridge this gap and support family engagement in skilled services. Recent literature focused on social determinants of health (SDOH) has suggested a potential digital divide has exacerbated the social and economic factors that create barriers to health and well-being (Clare, 2021). 

Looking Ahead – Future Projects addressing Telehealth Access, Equity & Implications for Occupational Therapy Practice

OTs should continue to focus on sustainability and clinical expansion of telehealth services through innovative hybrid care delivery models, including in-person care and use of telehealth in the plan of care, especially when serving within the school system and early intervention. OT practice and future research must consider the alignment of hybrid telehealth services with future health-based models, expanded programs, and new reimbursement structures (Kobernick, 2021). Practitioners should develop a research agenda and collaborate with other practitioners, practices, and between researchers on opportunities for clinical, research and educational inter-professional collaboration in order to conduct studies that address health equity/disparities and access to care for underserved populations (Terrell et al., 2021a). 

Little et al. (2021) suggest telehealth research, practice, and program evaluation in OT should be designed based on the four priorities outlined in the PACE Framework: 1) Population and Health Outcomes, 2) Access for All Clients, 3) Cost and Cost Effectiveness, and 4) Experience of Clients and Occupational Therapy Practitioners. Practitioners must measure the impact of socioeconomic, sociodemographic and other factors on telehealth adoption, access, and continuity of care in order to identify best practices, facilitators, and implement solutions to reduce digital health inequities, improve digital literacy, and mitigate disparities in telehealth (Baker-Smith et al., 2021). Future research should examine influencing factors to identify the reasons for the lack of adoption to digital health technologies. Equitable telehealth utilization requires special attention to underserved populations, embracing need for expanded infrastructure, aiding in digital tech literacy, and financial investments to provide quality care (Curfman et al., 2022). 

Researchers are encouraged to examine the effect of SDOH and client demographics on telehealth utilization in order to implement quality improvement and evaluate telehealth services while addressing known health disparities using data such as income, education level, primary language, insurance type, and socio-economic status. Additionally, researchers should study other inter- and intrapersonal factors influencing the use of telehealth (Hannemann et al., 2021). Future investigation should include health technology-related digital divide research and consider factors, such as reduction in healthcare disparities, equity and inclusion, availability of specialists, reduction in client wait times, digital health literacy, and client satisfaction (Chuo et al., 2020). 

Practitioners can mitigate digital inequities in telehealth by collaborating with community-based, state, and federal organizations to increase access to broadband internet and access to digital technology devices. Providers may also work to improve digital health capabilities and support services tailored to meet individualized client needs to overcome disparities, improve digital literacy and adoption to virtual-digital health platforms. For instance, consider a partnership with the Florida Alliance for Assistive Learning & Technology ( 

OT practitioners need to advocate to policy makers and other key stakeholders in order to highlight best practices that show the value of virtual care and support telehealth service delivery. Advocacy and policy work supporting sustainable reimbursement and funding is important to avoid the “Telehealth Cliff” for OT services, as our profession should be considered as key members of the multidisciplinary team (Terrell et al., 2021b) We encourage OTs to advocate to advance permanent telehealth reform by supporting federal and state legislative and regulatory efforts in key priorities, such as ensuring there are no restrictions made to the patient location, provider type, specific technology, and modality of care, to ensure our profession facilitates continued sustainability, growth, and innovation in occupational therapy telehealth service delivery.


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