Another way that the coronavirus has changed our world ? Telemedicine.
Prior to this year, most of us had never been on a video call with our physicians. But with stay-at-home orders and limited patient hours at many physician practices this spring, parents experienced Zoom or Skype appointments with obstetricians, pediatricians and other doctors.
The future is now
At Baltimore’s Mt. Washington Pediatric Hospital, psychologists found telemedicine to be a valuable tool. It’s one they had long hoped to use for counseling sessions, says Dr. Kenneth Gelfand, the hospital’s psychology manager. The hospital sees young patients from all over the state with a variety of medical issues. That includes feeding disorders, autism and long-term medical conditions.
The hospital’s counseling staff conducts about 25,000 patient visits each year.
For families with transportation issues or children who are immunocompromised, for example, the hospital’s practitioners had long hoped to serve patients through telepsychology. It was something for which his team had advocated for years, Gelfand says. When staff shifted gears in mid-March because of the pandemic, the chance to try telemedicine reinforced the ways it could be useful.
“For a lot of families, this really has created an equivalent level of care,” Gelfand says.
Many of the hospital’s teenage patients showed an “increased interest” in their appointments, because they didn’t have to take the time from busy schedules to come in for appointments, he says. For patients with anxiety, counselors were often talked with them as the anxiety was happening and gave them in-home strategies for coping and alleviating it.
Visits were conducted by Zoom, and with small children, staff did have to be “creative,” Gelfand says. Psychologists engaged kids with online games and activities, multimedia and the help of family. Many patients provided tours of their homes or introduced their pets, so practitioners learned firsthand about that child’s daily life. For kids with feeding disorders, psychologists could see them eating in their kitchens and offer valuable feedback and hints.
There were adjustments, of course. Implementing this new tool with patients with autism was initially challenging, Gelfand admits. Many children with autism found the changes in daily life during the pandemic to be stressful. But telepsych visits eventually provided structure for home and family, he says.
After the pandemic, hospital staff hopes that 10 to 20 percent of its counseling visits will continue to be remote. Face-to-face sessions remain important, of course, but telepsych can continue to be a tool for patients with transportation and other barriers, Gelfand says.
“In whatever a post-COVID world brings, telepsychology remains a tool for practitioners to use,” he says.
Help for military families
Before the pandemic, behavioral psychologists at Kennedy Krieger Institute in Baltimore used telehealth with military families at Fort Meade, Fort Detrick and Aberdeen Proving Ground. This was through a program the hospital started in 2016, says Dr. Jennifer Crockett, director of training with the department of behavioral psychology. The program later expanded to include families at Naval Air Station Patuxent River.
“Telehealth has such great applicability to military families, because it’s portable,” Crockett says.
And because Kennedy Krieger had success with this program, they were able to scale it up for other departments when COVID-19 hit. In fact, Crockett co-chaired a task force to make sure this happened.
Practitioners in every department, even physical and occupational therapies, worked with their patients via telehealth. This also includes inpatient services, Crockett says, adding that a practitioner at a child’s bedside could use technology to connect with a speech therapist, a physical therapist and a parent to talk through that child’s care needs.
“We find children take to it well,” she says.
But so do parents. Crockett often works with children as young as 2. In those instances, a telehealth call centers on coaching the parent in behavioral strategies rather than engaging a child who might not be interested in Zoom.
“One of the benefits that we suspected we would see, and we have seen, is that parents are saying, ‘I’m getting this quicker now because I’m doing it,’” Crockett says. “They are not watching us do something. They’re doing it, and they’re doing it in their own homes.”
Telehealth also has been a good way for practitioners to connect with children feeling anxious because of the extreme disruptions in their life, Crockett says.
In addition to its inpatient and outpatient services, Kennedy Krieger also has a school program that provided distance learning to its students this spring.
“Oftentimes people think that kids with special needs can’t use technology,” says Lisa Nickerson, assistant vice president of marketing, public relations and communications. But that would not be true, she adds. With the help of their parents and teachers, students completed many lessons through tele-education.
Like other schools, the biggest issue was accessibility; not all students had computers. That’s something the hospital works hard to overcome with its patient families. Crockett says she looks for grants that allow the hospital to purchase laptops that can be loaned to patient families as well as other ways to improve access to care. She adds that families should not be deterred from seeking help for their child because of technology.
And after COVID-19? Crockett hopes that telehealth remains a care option for Kennedy Krieger patients.
“There’s still so much that is unknown,” she says. We’re still working every day to continue to ramp up the process. COVID gave us the opportunity to jump into telehealth. I hope people see the value in it.”