Telehealth: Virtual Service Delivery Updated Recommendations
As school psychologists are called on to provide services remotely, questions continue to arise regarding legal, ethical, and pragmatic limits on what activities school psychologists can and should perform. Because students, families, and our colleagues need support during this time, and because we cannot be physically present with them to provide such supports, we are obligated to figure out how to best provide support within the limitations imposed by the COVID-19 crisis. As noted in the first remote service delivery document, because every situation is different, an ethical lens is important in developing responses and taking responsibility for them. An equity lens must also be used so that the most vulnerable youth are not further disadvantaged by decisions that neglect their needs. Finally, it is important to use a preventive lens; we are trying to mitigate long-term effects from the crisis and be well-positioned to serve when schools reopen. What follows are some recommendations for navigating the COVID-19 crisis.
Definition of telehealth
For the purposes these recommendations, telehealth is defined as any school psychological service that is being provided remotely—that is, without being in the same physical space as the individuals who are receiving services. Generally, a state-issued credential to provide school psychological services does not limit the ability to provide telehealth services. Although most school psychologists will benefit from continuing professional development in best practice for telehealth service delivery, it is permissible under NASP’s ethical standards to provide services remotely that an individual has the skills to deliver face-to-face, so long as the particular practices are appropriate (or appropriately adapted) for this delivery modality. Note that telehealth service delivery includes technology-based services (e.g., using Zoom or other video platforms, email) as well as more traditional methods (e.g., phone calls, notes or resources sent via standard mail).
General Practice Recommendations
- Services requiring face-to-face interaction should not be conducted during the time of school closures while the risk of contagion is high, as this practice places the health of the student, family, and practitioner at risk. Such practices could also yield unreliable or invalid results.
- When making decisions about practice, follow a detailed, ethical decision-making process as reviewed in the prior guidance document and the COVID-19 “Ask the Experts” webinar series, especially the specific webinar “Legal and Ethical Decisions for Remote School Psychological Services.”
- Obtain specific parental consent (and, when applicable, student assent) to provide telehealth services. This informed consent includes discussing with parents any modifications or adaptations to services being provided, as well as limitations, risks, and benefits that result from remote delivery. Document everything you do.
- As many situations will not have perfect solutions, utilize collaborative problem-solving, ongoing evaluation (and documentation) of the chosen solution, and adjustment of solutions as needed.
- Assessments must be administered in the manner in which they were developed and validated. If adaptations are made for remote administration, there must be high-quality evidence that such adaptations produce results that are similarly reliable and valid to the face-to-face administration. Any such adaptions should be documented in the evaluation report.
- Assessments should be administered remotely only on platforms designed for that purpose. Appropriate training is needed for both the school psychologist and any individual at home who assists the student. Even when appropriate supports are available, school psychologists should still identify and report any validity issues given the student’s level of anxiety, disruptions during the testing session, etc.
- Although rating scales, interviews, and possibly home-based observations could be conducted remotely, it is important to remember that students’ behavior during the time of school closure may not be typical for that student, which may reduce the utility of those assessments, particularly when planning interventions that may eventually be delivered when school resumes.
- Some reevaluation decisions can be made based on data available prior to the school’s closure. School psychologists should carefully consider whether there is sufficient evidence to support the continued need for special education services without further 1:1 testing for individual students.
- If the evaluation or reevaluation cannot be completed safely, ethically, and/or legally, school personnel should communicate with parents about this and request extensions to timelines until a date when the comprehensive evaluation can be completed with integrity. The federal government and state governments have provided guidance on the implementation of the Individuals Disability Act and where flexibility is appropriate, and this guidance is addressed in the COVID-19 “ Ask the Experts” webinar called, “Wading through a Sea of Ambiguity: Charting a Course for Special Education Services in the Pandemic.”
Counseling (Individual and Group)
- Consider whether the counseling goals that were in place prior to school closure remain relevant in the current situation. It may be more important to discuss current coping strategies, celebrate small successes, and plan for return to school, rather than focus on past difficulties. Discuss with students and parents and work with the IEP team to adjust IEPs as needed.
- Confidentiality agreements should be renegotiated as needed. It is unlikely that confidentiality can be assured for individuals or groups, and students need to be aware of that. Remember that confidentiality agreements can be different depending on the circumstances, but what is essential is that everyone knows what has been agreed to and is willing to follow the agreement.
- Be sure that you have plans in place to manage emergencies if students threaten harm to themselves or others. Be sure that parents know how to get help out of school hours (or when you are otherwise unavailable).
- Some students who do not currently receive services may need brief school psychological services during school closures. Work with school administrators to establish methods for students or families to contact you when such needs arise.
- Students may need to grieve a wide variety of losses, and it is important to allow for processing not just of obvious losses, such as deaths, but more subtle ones (e.g., loss of transition experiences like graduation or prom).
- Ask students to generate strategies that have worked for them in the past when they faced challenges. Ask them how those strategies might work now.
Consultation with Teachers and Administrators
- Teachers and administrators are figuring things out as they go, just as school psychologists are. Ask how you can be supportive. Find out what they think they are doing well and celebrate those steps. Ask for their ideas on how to best support students and families.
- Advocate for sensible workloads for teachers (and yourselves). Help administrators and other colleagues recognize that there will be a lot of time when neither students nor teachers will be available for instruction.
- Emphasize the need to maintain positive relationships with students. These relationships will likely matter more in supporting students’ eventual return to school than their academic work.
- Advocate for equitable access to whatever instruction is being provided. Be sure to consider the needs of low income, economically marginalized families, English learners, and the needs of students with disabilities. Some schools are providing hardware (e.g., Chromebooks), mobile hotspots, or alternatives to electronic communications (e.g., delivering materials to students at home). These ideas are discussed in the “Ask the Experts” webinars that address strategies for engaging and supporting parents and teachers during the pandemic.
- Depending on the history of your previous interactions, your teachers and administrators may not know what kind of valuable services you can offer at this time. Offer suggestions and educate them about the breadth of your skills and how they might be helpful at this time. The NASP COVID-19 “Ask the Experts” series offers suggestions for school psychologists for how they can better support their teachers and principals during the pandemic.
Collaboration with Families
- Ask families what they need and be respectful of their responses. Use this information to connect them with additional service providers if needed. Access your network of community supports, while remaining aware that the availability of these supports may also be impacted by the virus. The NASP COVID-19 “Ask the Experts” webinar entitled “Strategies for Engaging and Supporting Parents During the Pandemic” offers a view of what parents are experiencing and how school psychologists can be helpful.
- Provide encouragement and assist families in problem solving. Let them know you care and that they aren’t expected to know how to do this perfectly or even well.
- Work with colleagues to develop strategies for connecting with students and families that are not participating in remote learning activities. Be persistent in trying to develop supportive connections with these families.
- Be sensitive to the multiple demands on students and parents/caregivers during school closures, and keep expectations reasonable for availability and communication. While some parents are at home with their children, many may also be trying to balance home and remote work responsibilities. Additionally, many high school students may be in the role of caregiver for younger siblings if their parents are away from the home working and classroom demands might need to be adjusted for them.
- School psychologists may have great resources to share, yet emails sent to families may get lost amidst the many communications coming from the school. Consider working with the school’s or district’s web team to add a page on the website with available resources (e.g., handouts, websites, activities) so they are available when needed. Consider also how to communicate this information to families with limited internet access (e.g., newsletters by mail, delivering packets to students’ homes).
Be kind to yourself and others as we progress through this crisis.
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