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PFA Tips: Telehealth Appointments

By Alizah Patterson, MD, Pediatric Resident, PL-3 , The Herman & Walter Samuelson Children’s Hospital at Sinai

Download a printable version of “Telehealth Appointments”


In these difficult times of the COVID-19 pandemic, the way we do many things have changed. Healthcare is one of the areas heavily affected. Many healthcare providers are making telehealth appointments available to their patients. Doctor’s visits already induce anxiety in many children with autism, but having to adjust to telehealth visits may add another level of discomfort. What can you do to prepare for these visits and ensure they are productive?

What is telehealth?
Telehealth is a form of delivering healthcare services via remote communication, like phone or videoconferencing. Telehealth visits can be done with both the provider and the patient being at home, a provider being in clinic with the patient at home, or both being in-clinic but in different locations. Another method can be a therapist providing services in the home with a physician or other provider managing oversight via telehealth. These methods allow minimal to no physical contact between persons and prevent viral spread of COVID.

Before a telehealth appointment, a little preparation can go a long way
Unlike an in-person visit, telehealth appointments do require some prep work. First, you will need to prepare your child. Depending on your child’s age, this may look different. For example, an older child may be required to sit at a table, whereas a younger child may need room to move around or have toys that they can play with during the visit. You should also introduce your child to the device and the room/environment where you will be conducting the visit. A practice call may be beneficial. If your child will be wearing headphones, have them practice wearing them so they become familiar with the sensation on their ears.

In addition to preparing your child, here are a few things you will need for a telehealth visit:
• A reliable internet or data connection
• An electronic device that is compatible with your doctor/therapist’s telehealth platform with audio/video capability
• Headphones can help eliminate distractions during the visit both for you and for your child
• If your healthcare provider uses an app for telehealth, install the app and test prior to the appointment if possible
• A pen and paper to take notes can be helpful as your provider may not be able to give you written recommendations during a telehealth visit
• Inquire before the visit what materials you need to make the most of your appointment. For instance, you may need some toys or tools to use during a therapy appointment.

Think about the setting
Find a quiet place for the appointment without distractions. If possible, have other children or pets in another room with supervision as necessary. Turn off TVs, music, other electronic devices. Lots of things going on in the same room can make for an inefficient appointment, especially if you are doing virtual ABA, speech therapy, or occupational therapy. If a private room is not available, creating a separated area with a curtain or a trifold board at a desk may be an excellent alternative. The setting should also be optimal for you, as you may be the primary interaction your child has with the therapist providing you guidance.

What will happen during the visit?
Once you log on for your appointment, your provider will be the first person you see. In a visit with a physician, they will likely ask you questions about your child in the same manner they typically do during in-office visits. They will ask about your concerns, and in a well visit, will ask about things like diet, sleep, etc. The difference comes into play when the provider must conduct a physician’s exam. There is lots of information a provider can gather just from observing the child via video, but you may have to assist the provider in observing certain things. For example, the physician cannot listen to your child’s lungs via telehealth. However, they can observe how they are breathing just by having you or them lift their shirt to expose their chest. The provider may also ask you to do certain maneuvers with your child, such as a finger-to-nose test or standing on one foot. Therapy visits will look different for each child depending on the type of therapy and the age of the child, but you will likely need to interact with your child as instructed by the therapist.

Benefits of using telehealth
There are many advantages to using telehealth over in-person visits. The first is the convenience of having a visit in your own home, without waiting rooms and car travel. Since this is an environment your child is comfortable with, their behavior is likely to be more genuine. Many children also become anxious in a doctor’s office, due to negative experiences or just because it is a new environment for them. With telehealth, providers and therapists can observe your child’s behavior in a natural environment and provide you with techniques that you can practice at home.

Can telehealth visits be used to diagnose ASD?
Prompt and early diagnosis of ASD is key to opening the door for early intervention services and therapies. When in-person evaluations are limited or unavailable due to pandemic-related issues, telehealth evaluations are a good alternative. But how reliable is a diagnosis offered via telehealth? Few studies have been done to evaluate this, however, the ones that have been done have shown promising results, identifying up to 90% of children ultimately diagnosed with ASD in person.

How can behavior be managed via telehealth visits?
Telehealth can be used to manage behavior challenges, which have increased as children’s routines have been significantly disrupted. Telehealth visits are >90% effective in managing challenging behavior and are comparable to in-person behavioral therapy. Parents can learn ABA (applied behavior analysis) techniques via telehealth to increase or decrease behaviors. If you are looking for specific details, contact your local ABA providers and inquire whether they are offering telehealth services.

Some examples of activities that can be done with children via telehealth are:
• Simon Says – Both the ABA provider and the parent can participate in playing Simon Says with the child. This game involves receptive language, following directions, and social skills.
• Screen share flash cards – Telehealth behavior providers can share their screen and do flash card activities similar to the ones they would normally do in person.
• Lego challenge – Providers and parents can instruct the child to build a specific item. This can be done via verbal instruction or visual cue. Building with Legos can help with following directions, creativity, and visual-motor skills. Expressive language can also be incorporated by asking the child to explain what they are building or have them tell a story about it.

Telehealth visits are not right for everyone
How does your child interact with technology? Are they fans of tablets and cell phones or is it too much sensory stimulation for them? Have they ever video chatted with anyone? If your child has difficulty with screens and video chatting, telehealth visits may not be the best choice for you. They also may not be willing to interact with a provider via video. Lastly, if you have an urgent issue and feel your child needs to be seen in person, express this need to your healthcare provider and request an in-person visit.

Additional Resources

PFA Healthcare Articles

Tele-ABA Actvities for Kids

“Vanderbilt study affirms effectiveness, promise of telemedicine for autism evaluations”

© 2020 Pathfinders for Autism

 

 

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