Telehealth in School-Based Health Services

Abstract

All students have the right to education. Students with disabilities need support from health providers to achieve their potential at school. Barriers to health service provision exist including shortages of providers, waitlists for services, complexities of coordination between the health and education sectors, and more recently the COVID-19 pandemic. Given these barriers, some schools have been using telehealth to increase access to school-based health services; however, the literature is still emerging in this area. In this thesis, I used scoping review methods to explore the literature pertaining to telehealth use in schools. The first manuscript describes the characteristics of telehealth use in schools as depicted in 57 included articles. The findings elucidated who is providing services using telehealth and with whom, when they are using telehealth, how they are using telehealth, and why they are using telehealth in the schools. Based on the findings, I identified practice and research recommendations. The second manuscript delves into the factors that influence telehealth use in schools. We used diffusion of innovations theory to categorize statements in the 57 included articles to identify factors that influenced telehealth implementation in schools. These categories included the features of the telehealth itself (the innovation), the communication about telehealth, the process of deciding to use telehealth (time), and the social system. The findings pointed to at least four key factors that influence implementation of telehealth in schools. The final concluding chapter integrates the findings from the two studies with overarching ideas about technology complexity, access to services, and current knowledge. Additionally, implications for schools, health providers, and specifically occupational therapists are provided along with policy implications.