Covering the distance: Can we better support children living in rural America through telehealth?

Posted in Disparities Intervention

     In March of 2020, the world collectively experienced a dramatic increase in the use of telecommunication, shifting from solely in-person medical care. Part C early intervention services were no exception to this side effect of the COVID-19 pandemic, and caregiver coaching provided through telehealth via video conferencing became more accessible to everyone for a brief period of time. Five years later, services have primarily resumed in-person, and yet, there are several communities who would continue to benefit from telehealth early intervention services. One of the largest, often forgotten communities, are those living in rural America.

     Many children and their families live in communities away from the larger urban areas, where many universities, research facilities, large healthcare facilities, and lawmakers decide how to best serve them. According to the Center for Disease Control (2024), children between two and eight years of age who live in rural areas experience mental, behavioral, and developmental disorders at a rate 3.5% higher than their urban-dwelling counterparts. To further complicate matters, they face additional barriers, including geographic isolation, difficulty with transportation, higher poverty rates, and lack of providers, leading to an overall decrease in access to services, including early intervention.

     Varying initiatives have taken place to help address the unique challenges faced by the rural populations of America, one of which is increasing access to telehealth. Outcomes from telehealth used to implement early intervention services in rural communities, however, have been decidedly mixed in relation to  child outcomes and family satisfaction. Simcoe et al. (2025) found higher fidelity of treatment plans for rural families in comparison to urban counterparts. Corona et al. (2021) found that although families were satisfied with telehealth, child outcomes were slightly lower than those receiving in-person services, and service providers noted additional barriers when using telehealth, including increased time needed to build rapport. Additionally, Fulton et al. (2024) found that children in rural communities were less likely to receive early intervention at all, and there was a negative correlation between rural families and satisfaction with telehealth.

     When pondering the relationship between outcomes and family satisfaction, there is a large piece missing from the Venn-diagram of successful early intervention: access. In 2023, Ko et al. found that there was no difference in willingness of rural versus urban families to access telehealth, however, there were additional perceived barriers for rural families. It appears that although telehealth shows promise in being an effective strategy, not all families are satisfied with the method nor has it been shown to be an adequate method to promote outcomes, which is pretty disheartening.

      On a positive note, several initiatives are currently underway to continue to help ease the ability for healthcare workers, including early intervention providers, to provide services to remote and rural families. Infrastructure is consistently highlighted as one of the biggest barriers for rural communities, including reliable access to high-speed internet. In 2024, the Department of Agriculture invested $433 million dollars to improve telehealth and high-speed internet to encourage telehealth use, decreasing the need for providers or families to be burdened with the task of traveling long distances. Although a lack of providers is a constant barrier to care, the use of interstate licensing compacts is paving the way for out-of-state providers to be available for telehealth services to rural communities when needed. As of 2017, the physical therapy interstate compact allows licensed providers from 39 states to provide services across state boundaries. It is anticipated that both occupational therapists and speech-language pathologists will be able to begin accruing their own interstate licensing in 2025.

      Although progress is being made with a variety of initiatives, barriers continue to exist. Molly Kimmel, Director of  the Rural Institute for Inclusive Communities notes that in Montana, legislation is lagging (personnel communication). Current telehealth services are provided only through an extension of a special COVID-19 law which originally allowed telemedicine; if that legislation were to be removed or the extension ended, rural Montana residents (nearly half the state’s population) would be unable to access those services.

     While there are clear efforts to increase ease of access to telehealth for professionals and families alike, the question remains of when we will be ready as providers to truly assist rural children at a distance? And in the meantime, as a practicing speech-language pathologist, I ask: what can we be doing to improve our professional services through telehealth, so that it is not a last-resort option but rather as effective and mainstream as the rest of our services? We know that rural children are not the only ones who would benefit from regular telehealth, and while we wait for infrastructure and licensure to catch up, it is our job to ensure the quality and readiness of our services are matching efforts as well.

Jordana Mancini, SLP (GUCEI’25)

References

  • CDC. (2024). Child Mental Health: Rural Policy Brief. Rural Health. 
  • https://www.cdc.gov/rural-health/php/policy-briefs/child-mental-health-policy-brief.html
  • Corona, L. L., Stainbrook, J. A., Simcoe, K., Wagner, L., Fowler, B., Weitlauf, A. S., Juárez,      A. P., & Warren, Z. (2021). Utilization of telemedicine to support caregivers of young children with ASD and their Part C service providers: a comparison of intervention outcomes across three models of service delivery. Journal of neurodevelopmental disorders, 13(1), 38. https://doi.org/10.1186/s11689-021-09387-w
  • Fulton, K., Terol, A.K., Hardy, A., Little, L., Stoffel, A., & Burke, M.M. (2024). Examining the Relation Between Telehealth Experiences in Early Intervention and Rurality Among Families of Young Children With Developmental Disabilities. Rural Special Education Quarterly.
  • Ko, J. S., El-Toukhy, S., Quintero, S. M., Wilkerson, M. J., Nápoles, A. M., Stewart, A. L., & Strassle, P. D. (2023). Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 39(3), 617–624. https://doi.org/10.1111/jrh.12759
  • Simcoe, K., Stainbrook, J. A., Chazin, K. T., Schnelle, E., Wagner, L., Hooper, M., Juárez, A. P., & Warren, Z. (2025). Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system. Autism : the international journal of research and practice, 29(1), 207–221. https://doi.org/10.1177/13623613241273081