Role and process change and satisfaction with an educational and developmental psychologist telehealth service for rural children

Objectives: This study explored a new telehealth educational and development psychologist (EDP) service 10 provided as part of a multidisciplinary team to rural families. We aimed: 1) to examine the role and process changes made in telehealth consults compared to in-person consults, and 2) to evaluate the satisfaction of key stakeholders with the telehealth service. Method: We used an exploratory qualitative case study design involving care observations, semi-structured interviews and satisfaction surveys. Participants were i) one EDP, four multidisciplinary team (MDT) members and six service managers 15 employed by BUSHkids, a not-for-profit health service in Queensland, Australia; and ii) 23 parents of 20 children enrolled in the service. Results: Telepsychology involved major additions to in-person roles and processes, including the creation of a telehealth facilitator role. Key role and process changes were identified: 1) extending MDT roles to assist the EDP with clinical data collection and extending parent roles to act as co-therapists; 2) increased clinician processes focused around maintaining 20 therapeutic presence through verbal interaction strategies and creating shared virtual spaces; and 3) increased routines and documentation demonstrated in extra EDP preparation time, additional technology sub-routines, and more correspondence between team members. Service satisfaction was rated as moderate-high by the EDP, MDT, and parents. Conclusions: Telepsychology, while requiring significant practice change, was an acceptable way to delivery educational and developmental psychology services. What is already known about this topic: Emerging evidences suggests telemental healthcare for children and adolescents is comparable to in-person services in diagnostic acuracy, attainment of clinically relevant improvement, and perceived therapeutic alliance. Evidence for telehealth adoption in pediatric populations usually focuses on clinical effectiveness, rather than psychologist experience of shifting from in-person to telehealth practice. Preliminary evidence suggests telehealth involves significant change in clinician roles and processes. What this paper adds: In this rural multidiscipliniary team, the adoption of an EDP telehealth service involved the addition of a new role (telehealth facilitator) as well as multidisciplinary team and facilitator role expansion involving feeding back some clinical information to the clinician, as well as parent role expansion relating to keeping children engaged in therapy. Additional work processes were also observed as the psychologist used verbal comments and shared virtual spaces to established their presence at a distance, and introduced new work subroutines to prepare for telehealth consults and manage telehealth technology. Role and process changes were not observed to clinician authority or disrupt core clinical roles such as triage, intake, formulation, treatment, review or discharge.