Telepartners - Year One Progress Report

Year One Progress Report (July 1999)

Telepartners in Early Diagnosis and Intervention
for Children with Disabilities in Remote Communities

Stephen Sulzbacher, Ph.D.
Depts. of Psychiatry and Pediatrics
Univ. of Washington, Seattle

Introduction
Rural families must travel long distances to find specialty care for diagnosis and treatment of children with disabilities. Financial and sociocultural barriers often prevent them from seeking care. Even if the children are lucky enough to find the right specialists, written reports to the Local Education Agency (LEA) recommending educational interventions are frequently unclear or unworkable in the local community where services and specialty training are lacking. The expense of travel is a barrier as it reduces access to follow-up service. Additionally, time-stressed local service providers and primary care health practitioners have little opportunity for interactive consultation with appropriate distant experts about low-incidence disorders affecting educational programming and often don’t have the time or the readily-available e-mail technology to consult with each other across town. The overriding problem then remains one of bringing together all the relevant agencies to produce a coordinated individualized education plan (IEP).

We are applying a proven model of outreach from the University of Washington to seven remote rural communities in Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) to provide needed services for children with disabilities. We are using the existing WWAMI Rural Telemedicine Network for early identification and ongoing consultation via interactive video teleconferencing (IVTC). The project is expanding the availability of specialty consultation for children birth to 21 years, with emphasis on those aged 3-12 for whom the LEA needs advice about medical conditions affecting educational progress. The use of IVTC will enable more school and community representatives to consult directly with distant specialists rather than requiring the child (and family) to travel to a distant center for diagnosis and intervention recommendations.

Objective #1: Technical Consultation and Development

Initial IVTC meetings with each participating site
These meetings included educators and health care professionals. The purpose of the meetings was to introduce the project to the key professional players in each of the communities who are or will likely be using the equipment for consultations. It gave them a chance to see the equipment in use, and it gave all of us a chance to "see" each other as we move ahead with the project.

We are also working with many school districts in Washington state who are just now getting T-1 lines as part of the K-20 Internet access system mandated by Governor Locke. That mandate, however, left unfunded the need for technical assistance to use these phone lines for videoconferencing purposes. We have been pleased school districts see us as a resource in this regard.

Objective #2: Direct Student Consultations

Consultations and consultant training
So far we have performed over 20 consultations as part of this project (see report from WSCCHAP for data on the larger number of consultations made through that related project). The total number of consults is more than half of what we predicted we would do before the end of our first grant year. Additionally, seventeen University of Washington and Children’s Hospital consultants were provided one-on-one "hands-on" training on the telehealth equipment. Each training took approximately 20-30 minutes and included background information on the project as well as technical training on how to place a televideo call and how to manipulate the volume, picture, and camera.

Objective #3: Inservice Continuing Education via IVTC

IVTC distance learning planning session
We have had one IVTC planning session with representatives from the Aberdeen School District and expect to make that site a focus for development of an inservice continuing education model in Year 2. We also performed a training on hand held adaptive/augmentative devices that was not included in our original timeline but was done at the request of both education personnel in Aberdeen as well as the trainer.

All site IVTC presentation
Instead of doing a bridged introductory meeting between our deans at each of our telepartnering sites, we developed a videostreamed welcome from them on our Web site. We continue to experiment with newer and better audio-videostreaming software and hardware.

Objective #4: Dissemination

Regional and national meetings
Staff have attended and presented at five regional and national meetings since January, 1999. In January, Ms Dyck, our project manager participated in a rural telemedicine grantees pre-conference workshop on telehealth projects developed for school systems. Dr. Sulzbacher, the co-principal investigator, was a panelist at a day long training on children’s psychiatric conditions where he presented information about Telepartners. Later that month Dr. Sulzbacher and Mr. House, project director, presented the Telepartners project to the NW Regional Rural Health Conference in Spokane. Dr. Sulzbacher also participated in a telephone conference during the American Telemedicine Association annual meeting.

Web site development
We began developing the Telepartners web site in November and continue to refine it. Its URL is http://depts.washington.edu/wwami/index.html. This site is being developed not only to publicize the project but to also offer participating communities the opportunity to submit consultation requests online. Additionally, we plan to provide educational materials to LEAs and Seas via videostreaming from this site in order to disseminate the latest theories and practices to address the educational needs of children with disabilities.