School-based Telehealth is the provision of healthcare services into schools with a HIPAA-secure software over the internet. Telehealth is a mode of access to medical and behavioral health services and not a separate type of service. Many types of services provided in-person for acute and primary care can be provided through this mode of treatment access. A growing body of evidence dating back to the 1950s demonstrates efficacy, cost-effectiveness and patient satisfaction of telehealth services.

School-based Telehealthcare can include, but is not limited to, acute care of minor injuries and illnesses, chronic disease care, nutrition therapy, occupational therapy, physical therapy, medication management, clinical assessment interviews, individual and group counseling or psychotherapy, case management, chronic care behavioral health management, peer support, clinical supervision and case consultation and other clinical treatments. School-based telehealth services may be used as the sole source of assessment and treatment or used in combination with in-person services or HIPAA-secure treatment apps. See laws and guidelines for state and profession-specific restrictions and requirements.

Third party reimbursement for school-based telehealth is widespread and growing. Most third-party health insurances and Medicaid reimburse for school-based telehealth services. Some health insurances have separate conditions for school-based telehealth reimbursement. A growing number of states require reimbursement for school-based telehealth services that are comparable to in-person services. Additionally, many healthcare entities privately contract school-based telehealth service providers to cover shortage areas. Grant funding is also available to establish and grow school-based telehealth services.

Each profession that provides medical, behavioral or therapy services has Clinical Guidelines for providing school-based telehealth services.

State license regulations for school-based telehealth vary by profession and from state-to-state. There are resources available to help you identify and maintain compliance with the State License Requirements for School-based Telehealth.

Providing school-based telehealth services requires software that meets HIPAA-security standards and permits clinical staff to fulfill their HIPAA compliance duties. The software requirements for school-based telehealth will vary depending on the use-case, setting, record integration/sharing requirements (EHR/EMR integration) and other factors. In addition, no technology by itself is HIPAA compliant and each vendor may interpret their role and requirements differently. Identifying the appropriate software service provider can be overwhelming. It is highly advisable to speak with a mentor and clearly define a use-case and business model prior to selecting technology and software. (Technology Selection Toolkit, Comparison of School-based Telehealth Software).

After the initial setup of the program, the role(s) needed to set up and facilitate school-based telehealth services will depend on many factors such as setting, size of the organization, the scope of services, business model and the support needs and preferences of the clinical staff and treatment population. In a typical setting, a clinical provider will be on one side of the video call and a presenter or facilitator will be on the patient side to facilitate the patient/client access. This presenter is often the school nurse or another member of the school staff.

The types of settings for school-based telehealth are school nurse office, dedicated space in the school, school-based health center, and mobile vans or buses. Clinical providers may be located either at a clinic, a hospital or the provider’s home, depending on the payment model, technical setup and organizational policy.

Running a new school-based telehealth service is simple, once established. However, it is challenging to design a new school-based telehealth service without experience and knowledge or a broad range of content areas that periodically change. Startup entails activities like creating clear use-cases, creating a school-based telehealth business model, building referral systems, selecting and setting up HIPAA-secure software and secure technology, creating school-based telehealth-specific content, creating new school-based telehealth HIPAA administrative procedures, creating service policies and procedures, and complying with school-based telehealth professional guidelines and state license laws for each profession. To overcome the complexity of starting up, it is recommended that the organization engage with a mentor or consultant to efficiently guide the startup through the initial steps to achieve proficiency in the near term.

A large and growing body of peer-reviewed research has established the efficacy of school-based telehealth services. Part of the difficulty in identifying research comes from the wide variety of terms used to describe this mode of treatment (school-based telehealth). The NETRC maintains a database of research on school-based telehealth. Telehealth Resource Center advisors can help connect you to research resources and research partners.

Dr. Steve North and Amanda Martin, leaders of the innovative Health-e-Schools program in North Carolina, share a 30-minute introduction to School-Based Telehealth.