- June 2020
- Fast Focus Research/Policy Brief No. 49-2020
In response to the Covid-19 pandemic, many human services agencies have had to quickly shift to remote case management, using whatever tools are available. In normal times, developing a comprehensive remote system might involve planning, piloting, and iterating repeatedly before beginning wide-scale implementation. Although agencies may not have sufficient time to conduct such a robust planning cycle, the experiences from telehealth and remote home visiting programs can inform their services during the crisis.
This brief summarizes findings from roughly 40 sources, including case studies, resource documents, and implementation guides from various telehealth and home visiting organizations, to outline the lessons learned from telehealth and remote home visiting programs for parents. The health care field has made significant progress in implementing telehealth services such as messaging, online educational content, and remote visits with providers. In addition, home visiting programs for parents have also had some early successes with remote case management.
Keeping key lessons in mind can help providers shifting to virtual services.
Several lessons learned from telehealth and virtual home visiting programs are especially relevant to virtual case management during the pandemic, such as the following:
- Put the client experience at the forefront. Consider clients with limited internet access or device access and prioritize and communicate processes to ensure client privacy and confidentiality.
- Pair technology-oriented and mission-oriented individuals within your organization to build an intuitive workflow.
- Recognize that your initial processes or systems will likely miss some components and be prepared to adapt.
- Create training that is simple and direct to best engage and prepare staff.
- Identify several champions—motivated individuals within your organization—to help lead the change and provide support to others throughout the transition.
- Closely monitor the implementation of virtual technology practice and adjust as needed, focusing on immediate issues.
- Prioritize and communicate processes to ensure client privacy and confidentiality. This may be especially important for certain populations such as victims of intimate partner violence living with their abusers.
Telehealth offers potential solutions for barriers to virtual case management.
Table 1 identifies specific barriers to remote case management that human services agencies may face. When available, potential solutions are also provided. Note that not all barriers have potential solutions that fully resolve the issues at hand and some recommendations may be hard to implement.
Further, not all populations have the same experiences or challenges with telehealth. Particular barriers experienced by rural and low-income clients may include limited access to the internet (see Figure 1) or unstable connectivity, and some clients may not be familiar with (or own) devices suitable for remote services. Clients may need support in understanding and growing comfortable using the technology and adapting practices for remote context.
|Setting up a remote system may require high upfront costs to cover technology, training, and equipment||
|Shifting to a remote system may require changes in program rules and processes||Staff may find technical or policy decisions hard to understand or inflexible||
|Some behaviors are more difficult to observe (e.g., intoxication, client reactions to questions) using remote technologies than during in-person sessions||
|Some environments are more difficult to observe (e.g., home safety for children, elderly) using remote technologies than during in-person sessions||
|Some clients may require shorter session lengths to account for increased distractions, such as caring for a child, in remote sessions compared to in-person sessions; in addition, clients with disabilities may have difficulty focusing for longer remote sessions||
|Shifting to a remote system requires agency buy-in and training||Staff may be unfamiliar and uncomfortable with the technology||
|Generating internal staff interest and use may be challenging||
|Remote case management may present challenges to client engagement||Clients may miss the social contact of in-person meetings||
|It may be more difficult to build trust between client and provider remotely||
|Facilitating group meetings may be more challenging||
|Establishing definitive boundaries between staff and clients may be more difficult as clients may be more likely to reach out to staff during nonbusiness hours using remote communication than standard business practices||
|Shifting to a remote system requires that clients have access to broadband and internet-enabled devices and understand how to use the technology||There is limited broadband access (particularly in rural areas) and access to devices (particularly for people with low incomes)||
|Bandwidth may be limited (especially during peak demand and for clients relying on cell service)||
|Technology may be unfamiliar to clients, especially among older adults||
|Remote systems may raise new concerns around privacy and require agencies to develop new processes to protect the privacy of clients||Certain populations such as victims of intimate partner violence may not be able to speak freely in their homes||
|The most readily available software may not provide the best privacy or meet HIPAA requirements||
|General privacy concerns||
Lessons learned from the telehealth field show that thoughtful, planned deployments of remote technology, paired with helpful documentation and ongoing training for staff, have the best likelihood of benefitting clients. While human services providers should consider all these factors when transitioning to and further developing their remote service platform, growth in telehealth usage during the Covid-19 pandemic has been explosive and it will take time for the research literature to catch up. Further, some findings from previous work could well be modified as more is learned about virtual assistance in the human services field.
Abazeed, A. & Benton, A. (2020). Improving human services using virtual technical assistance: Research brief. Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.
American Health Information Management Association. (2017). Telemedicine Toolkit. Chicago.
American Telemedicine Association. (2013). Practice guidelines for video-based online mental health services. Washington, D.C.
Bigelow, K. M., Walker, D., Jia, F., Irvin, D., & Turcotte, A. (2020). Text messaging as an enhancement to home visiting: Building parents’ capacity to improve child language-learning environments. Early Childhood Research Quarterly, 51, 416–429.
Bobinet, K., & Petito, J. (2015). Designing The Consumer-Centered Telehealth & eVisit Experience. Felton, CA: EngagedIN.
Carta, J. J., Lefever, J. B., Bigelow, K., Borkowski, J., & Warren, S. F. (2013). Randomized trial of a cellular phone-enhanced home visitation parenting intervention. Pediatrics, 132 Suppl 2(Suppl 2), S167–S173.
Cimperman, M., Brenčič, M. M., Trkman, P., & Stanonik, M. D. L. (2013). Older adults’ perceptions of home telehealth services. Telemedicine and e-Health, 19(10), 786-790.
Commonwealth Fund. (2013). Case studies in telehealth adoption. New York City, NY.
Council of Economic Advisors. (2019, September). The state of homelessness in America. Washington, D.C. The Executive Office of the President of the United States.
Cubanski, J. (2020, April 13). Possibilities and limits of telehealth for older adults during the covid-19 emergency. The Henry J. Kaiser Family Foundation.
Dorstyn, D. S., Mathias, J. L., & Denson, L. A. (2011). Psychosocial outcomes of telephone-based counseling for adults with an acquired physical disability: A meta-analysis. Centre for Reviews and Dissemination (UK).
Forducey, P. G., Glueckauf, R. L., Bergquist, T., Maheu, M. M., & Yutsis, M. (2012). Telehealth for persons with severe functional disabilities and their caregivers: Facilitating self-care management in the home setting. Psychological Services, 9(2), 144–162.
Glueckauf, R. L., & Noël, L. T. (2011). Telehealth and family caregiving: Developments in research, education, policy, and practice. In R. W. Toseland, D. H. Haigler, & D. J. Monahan (Eds.), Education and Support Programs for Caregivers: Research, Practice, Policy (pp. 85–105). Springer.
Great Plains Telehealth Resource and Assistance Center. (2014). gpTRAC Toolkit.
Gros, D., Morland, L., Greene, C., Acierno, R., Strachan, M., Egede, L., Tuerk, P., Myrick, H., & Frueh, B. (2013). Delivery of evidence-based psychotherapy via video telehealth. Journal of Psychopathology and Behavioral Assessment, 35.
Hall, C. M., & Bierman, K. L. (2015). Technology-assisted interventions for parents of young children: Emerging practices, current research, and future directions. Early Childhood Research Quarterly, 33, 21–32.
Indian Health Service. (2018). TeleBehavioral Health Center of Excellence Toolkit. Washington, D.C.
Kaiser Family Foundation. (2020). Possibilities and limits of telehealth for older adults during the COVID-19 emergency.
Lefever, J. E. B., Bigelow, K. M., Carta, J. J., Borkowski, J. G., Grandfield, E., McCune, L., Irvin, D. W., & Warren, S. F. (2017). Long-term impact of a cell phone–enhanced parenting intervention. Child Maltreatment, 22(4), 305–314.
Lilibridge, J., & Hanna, B. (2008). Using telehealth to deliver nursing case management services to HIV/AIDS clients. OJIN: The Online Journal of Issues in Nursing, 14(1).
Medicaid and CHIP Payment and Access Commission. (2020). Report to Congress on Medicaid and CHIP. Washington, D.C.
Merrell, R. C. (2015). Geriatric telemedicine: Background and evidence for telemedicine as a way to address the challenges of geriatrics. Healthcare Informatics Research, 21(4), 223–229.
Moczygemba, L. R., Cox, L. S., Marks, S. A., Robinson, M. A., Goode, J. V. R., & Jafari, N. (2017). Homeless patients’ perceptions about using cell phones to manage medications and attend appointments. International Journal of Pharmacy Practice, 25(3), 220-230.
National Consortium of Telehealth Resource Centers. (2018, May 17). Telebehavioral health strategies for rural hospitals & clinics.
National Consortium of Telehealth Resource Centers. (2019, April 18). NCTRC webinar – Telemedicine: How to do it right!
National Consortium of Telehealth Resource Centers. (2019, November 21). NCTRC Webinar – Redesigning care in series based care: Obstetrics and autism caregiver training.
National Consortium of Telehealth Resource Centers. (2020, March 31). COVID-19: The use of telehealth in long-term care settings during this national emergency.
National Council on Crime and Delinquency. (2020, March 25). Child welfare safety assessment and planning during COVID-19 and physical distancing.
Olsen, S., Fiechtl, B., & Rule, S. (2012). An evaluation of virtual home visits in early intervention: Feasibility of “virtual intervention.” Volta Review, 112, 267–281.
RAND Corporation. (2019). Experiences of Medicaid programs and health centers in implementing telehealth. Santa Monica, CA.
Rhoades, H., Wenzel, S. L., Rice, E., Winetrobe, H., & Henwood, B. (2017). No digital divide? Technology use among homeless adults. Journal of social distress and the homeless, 26(1), 73-77.
Robert Wood Johnson Foundation. (2012, February 15). Using telehealth for mental health.
Sanders, M. R., Dittman, C. K., Farruggia, S. P., & Keown, L. J. (2014). A comparison of online versus workbook delivery of a self-help positive parenting program. The Journal of Primary Prevention, 35(3), 125–133.
Scherer, M. J. (2002). Assistive technology: Matching device and consumer for successful rehabilitation (pp. xiii-325). American Psychological Association.
Scherer, M. J., Sax, C. L., & Glueckauf, R. L. (2005). Activities and Participation: The Need to Include Assistive Technology in Rehabilitation Counselor Education. Rehabilitation Education, 19.
Substance Abuse and Mental Health Services Administration. (2016, November). In Brief: Rural behavioral health: Telehealth challenges and opportunities.
Supplee, L., & Crowne, S. (2020, March 26). During the COVID-19 pandemic, telehealth can help connect home visiting services to families. Child Trends.
Swenson, K. & Ghertner, R. (2020). People in low-income households have less access to internet services. Office of the Assistant Secretary for Planning & Evaluation, U.S. Department of Health & Human Services.
Taylor, T. K., Webster‐Stratton, C., Feil, E. G., Broadbent, B., Widdop, C. S., & Severson, H. H. (2008). Computer‐based intervention with coaching: An example using the Incredible Years Program. Cognitive Behaviour Therapy, 37(4), 233–246.
Thorp, S. R., Fidler, J., Moreno, L., Floto, E., & Agha, Z. (2012). Lessons learned from studies of psychotherapy for posttraumatic stress disorder via video teleconferencing. Psychological Services, 9(2), 197.
Totten, A. M., Womack, D. M., Eden, K. B., McDonagh, M. S., Griffin, J. C., Grusing, S., & Hersh, W. R. (2016). Telehealth: mapping the evidence for patient outcomes from systematic reviews. AHRQ Comparative Effectiveness Technical Briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); 2016 Jun. Report No.: 16-EHC034-EF.
Waters, A., Winston, P., & Ghertner, R. (2020). Virtual case management considerations and resources for human services programs. Office of the Assistant Secretary for Planning & Evaluation, U.S. Department of Health & Human Services.
Wrape, E. R., & McGinn, M. M. (2019). Clinical and ethical considerations for delivering couple and family therapy via telehealth. Journal of Marital and Family Therapy, 45(2), 296–308.
U.S. Federal Communications Commission, Promoting Telehealth for Low-Income Consumers: COVID-19 Telehealth Program, Report and Order, in WC Docket Nos. 18-213 and 20-89; FCC 20-44, adopted March 31, 2020 and released April 2, 2020.
U.S. Department of Health and Human Services, Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation (ASPE). (2016). E-health and Telemedicine. Washington, D.C.: U.S. Government Printing Office.
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. (2017). Using telehealth to identify and manage health and substance use disorder conditions in rural areas. Washington, D.C.: U.S. Government Printing Office.
Zero to Thrive. (2020). Telehealth Service in Infant Mental Health Home Visiting.
Child Support, Children, Children General, Covid-19, Economic Support, Employment, Employment General, Family & Partnering, Family & Partnering General, Food & Nutrition, Food Assistance, Health, Health Care, Housing, Housing Assistance, Inequality & Mobility, Inequality & Mobility General, Justice System, Justice System General, Place, Place General, Unemployment/Nonemployment