The Potential—and Pitfalls—of Telehealth

The COVID-19 pandemic upended our way of life, changing how we go about everything – from managing our health to educating our children. One response to the social distancing this public health crisis has mandated is the wide use of virtual services for delivery of health, education, family support, and human services. If there was any doubt about the effectiveness of virtual services before the pandemic, experience now has shown they are more than just effective; they are a not-yet fully tapped asset. Their use represents an innovative and positive change in early childhood systems and services. On the other hand, solutions for the obstacles to their equitable use must be found.

Flexible Funds Allowed for Flexible, Meaningful Services
Many public and private funders established flexible arrangements to enable use of funds for purchase and donation of equipment, expanded access to Wi-Fi, and mobile phone minutes or data time.  The flexibility of federal funds was shown in many program areas. In some tribal communities, CARES Act funds allowed for the purchase of laptops for all child care providers. Early Head Start funds were used for virtual professional development. States were given flexibility to use Medicaid to finance virtual health services, from well-child visits to early intervention therapies, and most paid at parity with in-person visits.

The process has not been perfect: while some were able to make effective use of flexible funds, the federal and state rules on payments to providers and purchases for families (e.g., data and phone cards, laptops, tablets) varied by program and were confusing for many agencies and providers. Nonetheless, interview respondents reported better engagement, convenience, and continuity of care for families. Many providers in health, home visiting, Early Intervention, and early care and education, benefited from virtual professional development and supervision supported by states, programs, or associations.

The Digital Divide
“Virtual services” refers to a broad range of remote services through landline telephone, mobile phone, Internet, and other electronic communication. During the pandemic, these technology and virtual communications tools have been used for facilitating parent engagement, professional development, and decision making at the state and local levels. One of many issues underscored over these last several months is that technology is a facilitator and a barrier. While virtual services improved access and convenience for many families, the variations in access to digital tools and technology led to sharply defined inequities. Generational, geographical, and/or socio-economic (e.g., income, housing, or race-ethnicity) differences contribute to the “digital divide.” The success of these efforts rests upon the following capacities:

1. Access to hardware (e.g., computers, tablets, and smartphones).
2. Infrastructure to support the technology (i.e., access to broadband Internet with sufficient bandwidth to transmit audio and video data, software programs).
3. Skills to use these tools on the part of families and providers.

Communities and families with uneven or limited mobile telephone or Internet capacity have struggled more than others to ensure equity of access. As Chicago area maternal and child health leader Timika Anderson-Reeves noted: “The use of technology requires more support for our families.”

Other Virtual Service Concerns
Many providers serving families with young children showed their ability to rapidly pivot from clinic-, home-, and center-based services to virtual service delivery. As Dr. Cristina Pacione-Zayas, of the Erikson Institute, on the Illinois State Board of Education and a leader in Latinx educational equity, noted: “Our educators have done an amazing job attempting to do the impossible.” However, they had no choice but do so without best practice guidelines that would have helped them most effectively and efficiently provide services. Some advice and tips have now become available, but this is an area in need of further development. In addition, the virtual response to the pandemic has prompted concerns about cybersecurity and data privacy and confidentiality concerns, another issue requiring attention.

Providing services virtually over these last several months, when in-person services have not been possible, has resulted in positive outcomes. However, when it becomes possible to provide in-person services again, families should be provided a choice. It is especially important that families in marginalized communities, who historically have faced barriers to accessing services, not be forced into a model of service because it is cheaper or easier to deliver. Until the digital divide no longer exists, virtual services will not reach every family. Further, even when viable, the benefits of virtual services do not erase or replace the benefits of in-person services.

Moving Forward 
Virtual technologies can significantly enhance communication between families and providers not only during times of crisis, but on a regular and ongoing basis. These technologies should be seen as tools for supporting consistent, meaningful engagement. Moving forward, we will need to improve professional training and protocols for use of virtual services to ensure consistency and quality in service delivery. In addition, we will need best practice guidelines and protocols to support consistency in quality service delivery of the hybrid model the future likely holds. Finally, as Carrie Griffin Monica, leader of an advocacy organization in Louisiana, noted “COVID-19 demonstrated that virtual services are part of our future. We have to learn how to leverage the technology appropriately and not create greater equity gaps while doing so.” To accomplish this, we will need to invest public funds in the expansion of broadband Internet to make it affordable and more widely accessible.

About the Author

Ruth Trombka joined The BUILD Initiative in 2009 as its program manager and, in 2015, became its in-house editor and writer. In this capacity, she drafts various BUILD communication pieces, edits staff and consultant writing, and writes or co-writes BUILD blogs. Before joining BUILD, Ruth was the director of the State Improvement Grant in the Office of the State Superintendent of Education in Washington, D.C. Prior to that, she was the manager of early intervention programs for preschool children with autism in New York City, where she was born and raised. She has a B.A. in Spanish literature and an M.S. in education from the City University of New York.