(Grant #H324R980113 )

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 misunderstood or unworkable in the local community where services and specialty training are lacking. The expense of travel is a barrier to quality health care, 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

Site visits
One site visit occurred the first week of June, 1999. Dr. Sulzbacher flew to Petersburg, AK to visit with school district personnel and local health care providers. He also had an opportunity to use the televideoconferencing equipment located at the Petersburg Medical Center and view the University of Washington’s Medical Grand Rounds from that location. Rande Gray, technical director, accompanied Dr. Sulzbacher on the trip and spent time upgrading the televideoconferencing equipment. No other site visits were held over the summer months since school personnel were generally not available.

We are pleased to report that word of mouth and the availability within Washington state of a growing network of videoconferencing equipment at individual school districts has reduced the need to make on site visits. School districts are calling to request televideo consults based on word of mouth from other special education directors, and we are evolving a protocol to handle requests from districts where we have not had previous contact. This protocol involves an offer of an on site visit or a videoconference call between district administrators and our project investigators and administrators. To date, we have conducted four such conferences. Typically, we are finding it takes two administrative videoconferences before a school district is ready for a clinical consult. The first is between Rande Gray, our technical director, and a technician from the school district. Because school districts in Washington have been buying Zydacron (less expensive) telecommunications equipment, we have found it necessary to teach local technicians the bridging communication protocol to assure compatibility with our equipment. After a reliable connection has been established, the next meeting either involves either a video or telephone conference to clarify confidentiality, clinical protocol and paperwork procedures. We have then been able to smoothly conduct consultations. Therefore, we’ve found no need to conduct onsite inservices. However, as we move into the dissemination phase of our project, we anticipate using the travel funds for dissemination purposes, such as a paper on videoconferencing for rural school districts to be presented at the Western Society for Pediatric Research meeting in February of this year.

Other partnership developments
An example of our acceptance with other school districts is the Bainbridge Island project. We have been asked to provide ongoing consultation and distance learning. Several students have been identified whose special health care needs have prevented their school attendance, and we are working with the district in developing curricula tailored to these students’ needs. This involves televideoconferencing classes with UW consultants for which these high school students get credit. (See Supplemental Changes section for more details.) Thus far we have held three meetings: December 13, 1990, January 10, 2000, and January 18, 2000.

Interestingly, the Bainbridge Island School District was sufficiently impressed with the success of the initial consultations that they are preparing local grant proposals to continue the consultations after the end of the Telepartners Project period.

Use of the system
As we explained in last year’s report, Appendix A is a usage log developed to track the various activities of the program including who is using the system. Each activity is coded with a number. The log helps track how often a Telepartners consultant has consulted with a remote educator or health care provider, as well as meetings and conferences attended by Telepartners’ staff.

Inquiries from educators and health care providers
Since last May, we have received inquiries about the project from the North West Regional Education Library at the University of Oregon in Eugene (August) and health care providers from Omak, Washington (September). We also received requests for inservice training on topics such as ADHD and autism from the Yelm, Washington School District (October) and the Pomeroy, Washington School District (December). These inservice trainings have not yet been scheduled. We are waiting to hear back from both school districts as to the best dates and times they are available. In November we received a visit from a pediatrician at Case Western University in Cleveland, Ohio looking at developing a program similar to the Telepartners Project. Additionally, in November, the K-12 Institute on the University of Washington campus requested information from us to include in their catalogue of K-12 projects.

Project staff management committee meetings
Meetings between Peter House, Steve Sulzbacher, and Sarah Dyck (or a combination thereof) continue to occur approximately on a monthly basis. Dr. Sulzbacher and Ms. Dyck also continue to meet on a weekly basis to discuss project status.

Objective #2:Direct Student Consultations

Consultation statistics
For the totality of the first year of funding (October 1, 1998-September 30, 1999), we performed 29 consultations. Between May 19,1999, and Jan 25, 2000 we performed 27 consults. Of those consults, 8 were follow-up consults. A breakdown of the types of consults is provided below in Table 1.

In addition to our regular Telepartner sites, we completed consultations for several Washington school districts. The districts included the Chelan School District, Cashmere School District, Grand Coulee Dam School District, Bridgeport School District, Tri-Cities School District, and Bainbridge Island School District.

Objective #3:Inservice Continuing Education via IVTC

IVTC distance learning planning
As was mentioned under Objective #2, we have had requests from the Yelm School District and the Pomeroy School District for inservice distance learning opportunities. Both school districts are talking to their staff at this time to coordinate schedules as well as choose topics they would like to discuss (i.e., autism, ADHD, etc.).

We have also had discussions with the director of Continuing Medical Education in the School of Medicine (July and September, 1999) as well as general Continuing Education staff on campus about developing web-based and CD ROM based curricula on best practices. The director of CME has agreed to work with us in developing our curriculum but is somewhat hesitant about CME credits being paid for with credit cards over the World Wide Web. Thus, we are working with technical advisors from the Health Sciences Center for Educational Resources (HSCER) on how to provide the best security possible. The CE department has requested we send them a list of class topics and has indicated a willingness to work with us. Since we have been focusing much of our efforts thus far with the HSCER, we have not yet gotten back to the CE department.

In conjunction with HSCER, we have also developed a mock web site on the protocols and procedures necessary to conduct IVTC consultations. This site is not yet finalized, and, therefore, has not yet gone live. We will contact Bob Gilmore at OSERS as soon as the site can be viewed over the World Wide Web. Development of our web page and CD ROM curriculum has developed as meeting our client needs directly and has become a focus for our dissemination efforts. We have prioritized our specific curriculum topics as: 1) How to Conduct a Televideo Consult; 2) PKU (Phenylketonuria) and Other Low-Incidence Inherited Metabolic Diseases; 3) Autistic Spectrum Disorders.

Objective #4:Dissemination

Regional and national meetings
Telepartners and other UW based telehealth staff have participated in 7 regional or national conferences since May 19, 1999. They are listed in Table 2.

Other meetings
Telepartners staff also participated in a variety of local and state meetings since May of last year. Table 3 below lists each of the meetings.

Web site development
We’ve updated the Telepartners web site and continue to refine it. Its new URL is http://depts.washington.edu/wwami/index.html. This site not only publicizes the project but also offers participating communities the opportunity to submit consultation requests online. Additionally, we are developing educational materials to LEAs and SEAs via videostreaming and CD ROM from this site in order to disseminate the latest theories and practices to address the educational needs of children with disabilities. A message by Dr. Sulzbacher has already been posted on the Web site

Between September 1, 1999 and January 20, 2000, we received 2,412 hits to our web page, an average of 17 hits per day.

We have also completed the first version of a Web-based protocol for doing televideo consultations. However, this site is not yet live. We will be contacting Bob Gilmore of OSERS as soon as it can be viewed over the World Wide Web.

Brochures
Since May of last year we have distributed over 150 brochures at various state, regional, and national conferences.

Press releases and press coverage
Our project was reviewed in the April, 2000, issue of the APA Monitor, a monthly journal of the American Psychological Assn.

Leadership Advisory Committee Meeting
The date for the next Telepartners Leadership Advisory Committee is May 31, 2000.

Community Advisory Committee Meeting
The Telepartners Community Advisory Committee was held May 24, 1999. The minutes from this meeting are available in Appendix D. In sum, we discussed the progress of the project to date and asked the school representatives as well as parents to provide us with feedback as to what they would like the project to provide. They suggested developing actual videotapes of consultations to help educate parents on the value of doing consultations via IVTC. They would also like us to work with county public health nurses to identify children who could benefit from this project. It was also suggested we provide educational sessions via IVTC on services and resources available to parents and students, as well as work to develop ways to assure that children with borderline needs still get access to services.

The proposed date for the next meeting is May 19, 2000.

Dissemination of training materials
Educational sessions scheduled for the first project year were placed on hold until Year 2 due to the slow administrative startup (consultant training, advisory committee meetings, etc.) and because we have discovered the value of doing these sessions via the Web and on CD ROM in an asynchronous mode. Using the Web allows educators to view the training sessions at their leisure. Several administrative hurdles remain such as granting continuing education credits and mechanisms for on-line billing for those credits.

Bainbridge Island Project
As is discussed earlier in this report, we have been asked to provide ongoing consultation and distance learning by the Bainbridge Island School District in Bainbridge Island, Washington. Several students have been identified whose special health care needs have prevented their school attendance, and we are working with the district in developing curricula tailored to these students’ needs. This involves televideoconferencing classes with UW consultants for which these high school students get credit. The first test lecture the students watched (January 13, 2000) was done via recorded video over the televideo network of a lecture given by a computer network security specialist. The recorded lecture was used because the room where the lecture was given is not yet wired for televideoconferencing. We are exploring with various vendors the availability of portable ports that allow ethernet connections to plug into ISDN phone connections, thus making broadcasting of such lectures available whether or not a lecture hall is wired for ISDN.