AcuteCare Telemedicine Blog


Telemedicine is Closing the Gap Between Experts and Child Abuse Victims

Telemedicine’s entry into the healthcare process has been rather obvious over the past decade, particularly to those who have benefited from advanced stroke care, treatment for chronic diseases or convenient routine care for common illness. For those who live in areas away from advanced-care medical centers, telemedicine is closing the geographical gap to advanced, specialized treatment for stroke, diabetes and other coronary and neurologic disorders. As technology makes its way across the full spectrum of healthcare, providers are using the newest telemedicine technology to tackle one of their most difficult tasks: identifying a victim of child abuse or neglect.

Many cases of suspected child abuse arrive at hospital ERs, doctor’s offices or clinics where doctors and nurses can be less experienced in making a proper diagnosis. With the use of virtual technology the process of determining a proper diagnosis is enhanced, and the gap between child care experts and rural hospitals and advocacy centers closed. “We’ve saved lives, and we’ve saved families,” says Dr. Lori D. Frasier, division chief of child abuse pediatrics at Penn State Hershey Children’s Hospital.

The Department of Justice’s Office of Juvenile Justice and Delinquency Prevention and National Children’s Alliance provide financial support to more than 800 children’s advocacy centers across the country where treatment for victims of child abuse are benefiting from the use of telemedicine. It is also critical that a diagnosis of abuse be accurate. “The value is in the accuracy of the diagnosis,” says Patricia Goede, PhD, vice president of clinical informatics at XIFIN, “Over-interpreting something can be a huge cost to children and families.”

In Georgia, where much of the State’s populations reside in rural areas, the Children’s Healthcare of Atlanta Center for Safe and Healthy Children (CSHC) has used telemedicine since 2009. Jordan Greenbaum, M.D., Medical Director of Children’s CSHC says, “An evaluation utilizing telemedicine reduces parental anxiety and stress by providing prompt access to expert care and support. It also saves time and resources for authorities, who can lose a workday driving to and from Atlanta. And for rural medical providers, telemedicine relieves some of the burden of accurately identifying abuse and interpreting physical findings.”

In Florida a sharp increase in child abuse and a shortage of treatment specialist has exasperated an existing care differential between advanced care facilities and rural areas where child abuse rates are the highest. Providers in the state are working to expedite the development and initiation of telemedicine programs to address the growing problem. In the mid-west, at The Midwest Regional Children’s Advocacy Center at Children’s Minnesota, they’re utilizing the same platforms to share images and other tests and communicate with trained child abuse specialists.

Many formidable barriers to adoption and expansion of telemedicine remain, but as the utilization of the technology finds new and creative solutions across the range of medical services, closing the divide between specialized care and patients in need promises to remove many of the remaining, well-established opponents.



Telemedicine Contributes to the Education and Treatment of Autism

Using web-based technology to teach parents the strategies of applied behavior analysis (ABA) could offer big gains for kids with autism, new research suggests. In a small study of rural parents who participated in a series of online tutorials and videoconferencing sessions, researchers found that they could help moms and dads substantially increase their knowledge of ABA and apply the techniques without forcing the families to make long drives to a clinic. The finding could have particularly big implications for families living in remote communities that lack therapy offerings, researchers said.

“Autism spectrum disorders, now estimated to affect 1 in 68 children, are just as common in rural America, but ABA-trained professionals are rare,” said Linda Heitzman-Powell of the University of Kansas who worked on the study published in the journal Focus on Autism and Other Developmental Disabilities. Heitzman-Powell and her colleagues said the training method they developed, known as Online and Applied System for Intervention Skills (OASIS) helped parents increase their knowledge of ABA strategies by an average of 39 percent. What’s more, parents who took part in the training improved their implementation of the strategies by 41 percent overall, researchers said.

Four families with children on the spectrum participated in the study, each of whom completed a series of online tutorials and at least 13 videoconferencing sessions with a coach. Parents also used an online interface to report on their use of the strategies with their child. Since completing the initial study, researchers say they’ve further tested OASIS with nearly 40 families with similarly promising findings.

According to recent research, some 42 percent of U.S. hospitals have implemented telehealth platforms, with the highest levels of adoption occurring in rural areas. At Tift Regional Health System in Tifton, Ga., a telehealth frontrunner, they are operating several rural telehealth programs including programs providing telehealth at schools, an ADD and autism clinic, an emergency department stroke program, a program for patients undergoing kidney transplants, a geriatric psychiatric program and a program where patients can reach a provider 24 hours a day. “We believe in telehealth. We believe it’s the future,” says Jeff Robbins, director of the organization’s telehealth effort.

The ADD and autism clinic annually works for 600 children who often don’t have access to psychiatrists, endocrinologists, geneticists and other specialists. Some live more than three hours away, making monthly appointments challenging in terms of finding quality transportation and taking time off for caregivers. The program especially has impacted children from families with limited means, Robbins says.

On the eastern shore of Maryland, Atlantic General Hospital is the first hospital in the nation to partner with Kennedy Krieger Institute to provide telemedicine services to children with autism, ADD/ADHD, intellectual disabilities, and other developmental disorders living far from specialty care. Often a referral for specialty care means a trip to Baltimore and a six-hour round trip drive, with additional expenses for gas, food, parking and tolls. This can leave patients and their families exhausted before they even say hello to the doctor.

Dr. Deepa Menon, the assistant medical director at Kennedy Krieger’s Center for Autism and Related Disorders, and Dr. Paul Lipkin, the director of Kennedy Krieger’s Center for Development and Learning, are providing complete care, with initial evaluations and follow up visits, using encrypted telemedicine technology transmits both audio and video of the patient and doctor in real time. The physicians are able to interact with patients and their families in the same way they would in an actual exam room.

Children’s health care is a growing concern on a domestic and global scale among parents, specialists, and policymakers. Treating this special population, particularly among those living in rural communities, ignites continual challenges including insurance concerns, limited transportation, and the low number and availability of pediatric specialists. Telemedicine provides the best solution for providing much needed specialized treatment and education to those in need.