Children in large swaths of the country live in “neuropsychology deserts” with little or no access to expert care from pediatric neuropsychologists. Telehealth can shift the landscape, according to research by Lana Harder, Ph.D., Chief Neuropsychologist at Children’s Medical Center Dallas, part of Children’s HealthSM, and Professor of Psychiatry and Neurology at UT Southwestern.
Her groundbreaking 2020 study was the first to validate home-based teleneuropsychology and teleneuropsychological assessment of children.
“We found no significant difference in scores when a child was assessed at home using remote video conferencing or in a traditional in-person session,” said Dr. Harder. “These findings are especially important for kids who need one of the relatively few providers that specialize in their rare or complex condition.”
In this Q&A, Dr. Harder discusses how neuropsychologists can use telehealth to reach more families in need and what’s next in teleneuropsychology research.
Why does neuropsychology lend itself to telehealth?
A lot of our work, like doing intake interviews and sharing test results and treatment recommendations, involves talking with families. We can do this virtually or in person. A big question has been, “Can we also do neuropsychological testing in a virtual environment?” We’re learning – from studies with adults and more recently with children – that we can. The literature supports virtual testing for children as young as 6.
How can teleneuropsychology improve care?
Virtual care removes barriers – like distance, travel logistics and costs – which make it hard for families to get to us. Travel can be especially difficult for families managing complex medical conditions.
Wait times for full assessments tend to be long nationwide because testing can take eight to 12 hours, and there aren’t enough neuropsychologists to go around. Telehealth is a convenient way to offer families a brief evaluation sooner and give them resources while they wait for more extensive testing. Sometimes, a brief evaluation is actually enough to meet their needs.
There are other benefits, too. Telehealth reduces time away from school, work and family for the patient and caregiver. It also allows for physical distancing, which is important because many of our patients are immunocompromised.
Once they’ve tried it, how do providers feel about telehealth?
Research shows neuropsychologists are very satisfied overall using telehealth. It’s more flexible for everyone. The “show rate,” or percentage of patients who come to their appointment, is higher than for in-person sessions, so providers’ time is being used well.
What barriers have you and your patients encountered?
Technology for one. Not all families have reliable internet service and a suitable device. For some types of visits, a smartphone is fine. But testing requires a larger screen, like a tablet or laptop, for the material we need to present.
Insurance coverage can also be an issue. Insurers usually allow telehealth for neuropsychological services. But since the COVID-19 pandemic has waned, some no longer do. We need providers to advocate for continued coverage so families have ongoing access.
It’s also important to be clear on where a patient is and where you can legally practice. Some, but not all, states have adopted PSYPACT, the Psychology Interjurisdictional Compact. For those enrolled, it allows providers to practice across state lines.
What would you like to see next for research?
Though stagnant more recently, in the early years of the pandemic, research on teleneuropsychology surged, particularly in pediatrics. But many articles have focused on teleneuropsychology models, guidance to the field, or surveys of providers or consumers.
We need more research on the reliability and validity of virtual testing to move the field forward. We need to replicate earlier findings and study more of the assessment tools we use. We also need to study questions like:
How teleneuropsychology works for children with different conditions and at different developmental levels
How we go about virtual testing – for example, how we can engage parents if their child is developmentally younger and needs more support to participate
How we can use telehealth to see how a child functions at home
What resources can help neuropsychologists who provide, or want to provide, virtual care?
The guidelines on teleneuropsychology and telepsychology from the Inter Organizational Practice Committee and the American Psychological Association are great resources.
Some important practices to keep in mind:
Decide collaboratively with families about whether to use telehealth and how.
Use a HIPAA-compliant telehealth platform and follow laws about patient privacy.
Get informed consent from families to receive care virtually.
Provide instructions in the family’s preferred language.
Plan for issues that might arise during in-home sessions, like how to reach parents if they are needed during their child’s testing.
Children’s Health: A leader in pediatric neuropsychology
A skillful neuropsychological evaluation and carefully tailored treatment plan can help children overcome challenges at home, in school and in their communities. At Children’s Health, pediatric experts are working to give more kids access to neuropsychological services that support their success, both in person and virtually.
