With social distancing measures in place, many organizations have implemented virtual and remote services to support the health and social needs of the public during the COVID-19 pandemic. More than two-thirds of service providers in Community Solutions’ COVID-19 survey reported shifting their in-person work with clients to phone or video chat. We’ve seen more expansion specifically in telehealth, teletherapy and e-learning. Some have embraced this change, while others have expressed concerns. Research is ongoing, but more is needed in both clinical and non-clinical settings to better evaluate the costs, benefits and best ways to use remote services. Further consideration must also be put into strategies for methods of implementation as there are various challenges that could hinder effectiveness. One of the largest of these is the “digital divide” which includes varying levels of technological and digital literacy and availability. There is concern that, if permanent, the shift to remote delivery of services will leave certain groups even further behind.

Without proper access to technology, the internet or the knowledge of how to use it, individuals cannot take advantage of the benefits of telehealth or other remote services.

Telehealth

We have previously written about telehealth as it is defined by the Health Resources and Services Administration (HRSA).[1] The use of telehealth can aid social distancing efforts by triaging and reducing patient visits that may not require in-person services, thereby lowering possible exposure, transmission and unnecessary waste of medical resources.[2] Providers can also use telehealth to maintain routine follow-ups with for those with chronic diseases, mental or behavioral health issues, to ensure that continuity of care is not disrupted.[3] During this time of duress caused by the global pandemic, there may be a growing number of individuals who need this virtual support who didn’t previously, or who have experienced a flare up of previous conditions and symptoms.

Teletherapy

The American Psychological Association defines teletherapy as “the provision of psychological services using telecommunication technologies.”[4] Social distancing measures have led to isolation for many individuals and this, paired with issues resulting from things like job loss and grief, can have negative impacts on mental health. According to the Kaiser Family Foundation Health Tracking Poll conducted in April, 45 percent of adults in the U.S. said that concerns about COVID-19 negatively influenced their mental health. This was an increase from 32 percent in March.[5] In a meta-analysis conducted by the University of Pittsburgh, researchers examined whether mobile technology had positive effects on the outcomes of psychotherapy treatment and other behavioral interventions. The results suggested that clients who used mobile technology either as a supplement to treatment, or to contact their provider virtually, had better outcomes than those who did not, regardless of age, diagnosis or the type of technology.[6] Using mobile technology in treatment increased contact between providers and clients, and also improved client motivation and engagement. It also provided more real-time data on client patterns and experiences to aid providers in treatment planning.[7]

Clients, service providers and students also vary in their levels of comfort with technology and understanding how to use it.

E-learning

Online classes can make learning more accessible to broader audiences, and often allow individuals to learn at their own pace. However, research suggests that online instruction is not as good for student learning. A study by the Brookings Institution examined data on college students enrolled at DeVry University and found that students who took online courses performed worse than their in-person counterparts. Issues included a higher likelihood that students would drop out or enroll in fewer credit hours in following terms, as well as lower grades and GPAs.[8] In another study, Ohio K-12 students with a history of higher achievement performed better than those with a history of lower performance in online charter schools.[9] But, results also showed that, in most cases, high achievers’ performance was still lower than it would have been in traditional in-person public schools.[10]

The researchers concluded that that online schools are less effective for K–12 learners, because independent learning causes stress and some students do not have the skills needed to manage it.[11] The presence of teachers, peers and other individuals helps in the learning process. This is especially important now, as the pandemic is affecting 72 percent of the world’s population, including all of Ohio’s K-12 students.[12]

Further considerations in broadband access, digital literacy and implementation

Without proper access to technology, the internet or the knowledge of how to use it, individuals cannot take advantage of the benefits of telehealth or other remote services. Continuity of care and mental health could suffer, and students could underperform in school.

We often see that inequities in internet access are prevalent in both urban and rural communities, including in individuals who are low-income or have disabilities. According to the Federal Communications Commission (FCC), 21.3 million people in the U.S. did not have broadband internet.[13] Our previously mentioned piece on telehealth discusses how the digital divide has a clear correlation with racial gaps in neighborhoods.[14] Of all the households in Ohio, 9 percent do not own a smartphone, computer, or tablet, and 15 percent have no internet. [15] Pew Research states that 29 percent of adults with yearly incomes below $30,000 don’t own a smartphone and 46 percent don’t have a personal computer, while 44 percent lack broadband access. [16] According to a 2016 survey, disabled adults were less likely to have multiple devices with internet access than those without a disability.[17]

Clients, service providers and students also vary in their levels of comfort with technology and understanding how to use it.

On March 31, 2020, the FCC adopted the $200 million emergency “COVID-19 Telehealth Program” as part of the CARES Act, with a goal of supporting nonprofit and public health care providers’ ability “to ensure access to connected care services and devices” for low-income Americans and veterans. [18] The program has a goal of allowing eligible providers to apply for funding to reimburse eligible expenses or services. The funding would allow them to “purchase telecommunications services, information services, and devices necessary to provide critical connected care services, whether for treatment of coronavirus or other health conditions during the coronavirus pandemic.” [19]

Clients, service providers and students also vary in their levels of comfort with technology and understanding how to use it. This increases risks to continuity of care, opens the possibility of miscommunication or misinterpretation on health platforms and can result in inaccurate and/or incomplete examination of clients, or in clients not having full understanding of treatment plans, appointment scheduling, and other important health information. Teachers who are not technologically savvy may not be able to teach effectively on platforms, and parents may not have the necessary technological skills to assist. For students, this creates an inability to learn material and lowers engagement and participation in class.

If we hope to implement virtual and remote services effectively during this pandemic and beyond, providers may need further training on best technological practices for their services, and interventions to facilitate digital literacy in for their clients. Additional measures like the “COVID-19 Telehealth Program” may also be needed to increase access to broadband internet and technology. More research on other innovative ways to implement technology in services would be helpful, as we look to further protect the public from this pandemic. Since March, providers have been faced with the choice of providing services remotely or not providing services at all. But as social distancing restrictions loosen, providers should consider these aspects when determining how to provide services in the future.

[1] https://comsolutionst.wpengine.com/flatten-curve-raise-bar/

[2] https://www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf

[3] https://www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf

[4] https://www.apa.org/practice/guidelines/telepsychology

[5] https://www.kff.org/health-reform/report/kff-health-tracking-poll-early-april-2020/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633319/pdf/nihms725642.pdf

[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633319/pdf/nihms725642.pdf

[8] https://www.brookings.edu/research/promises-and-pitfalls-of-online-education/

[9] https://journals.sagepub.com/doi/pdf/10.3102/0013189X17692999

[10] https://journals.sagepub.com/doi/pdf/10.3102/0013189X17692999

[11] https://journals.sagepub.com/doi/pdf/10.3102/0013189X17692999

[12] https://en.unesco.org/covid19/educationresponse