Telehealth for ophthalmology visits: What parents should know

By Dr. Rahul Bhola, pediatric ophthalmologist and medical director of ophthalmology at CHOC Children’s

Like many physicians continuing to offer care during the COVID-19 pandemic, I have transitioned many appointments to telehealth, so patients can still get the care they need while practicing social distancing. At CHOC Children’s, we adjusted our policies and practices to maintain a safe environment for our patients and families who need in-person appointments.

For in-person appointments, we require masks and practice proper hand hygiene to protect the health of everyone we serve. Before entering our building, CHOC nurses screen all visitors and staff. Screenings include a temperature check and asking symptom and exposure-related questions. In line with CHOC’s limited visitor policy during the COVID-19 pandemic, only one parent/guardian may accompany the child for their appointment. Our clinic is taking other necessary precautions such as thoroughly disinfecting clinical areas and rearranging seating in our lobby to ensure social distancing.

Since March, my office has successfully completed over 900 telehealth visits, on top of non-elective in-person appointments.

dr-bhola-choc
Dr. Rahul Bhola, pediatric ophthalmologist and medical director of ophthalmology at CHOC Children’s

Since telehealth is new to many families, here’s an overview of what parents can expect at their first virtual appointment, plus answers to parents’ most common questions on telehealth for ophthalmology.

A synchronous (live audio-video) CHOC ophthalmology telehealth appointment is divided into four components. I call them the four C’s: Contact, Connect, Consult and Care.

  1. Contact
    Our front desk reaches out to the family to confirm their contact information. We send a Zoom link to the family, along with information about how to connect to Zoom and download a Visual Acuity app that we use during appointments to check vision.

 

  1. Connect
    As the appointment day approaches, our technician connects with the family to resolve any technical issues before the physician consultation. The technician also goes over the at-home visual acuity check and evaluates basic medical history.

 

  1. Consult
    On the actual day of the telehealth appointment, the physician connects with the family to go over the relevant medical history and visual acuity and performs focused examination including external and ocular motility exam. If needed, pictures and videos from the family can be sent to the physician for further evaluation. This enables us to diagnose a majority of anterior segment ocular issues, visual acuity concerns like amblyopia, refractive errors and ocular motility disorders.

 

  1. Care
    During the telehealth appointment, we discuss the treatment care plan and review any medical issues or concerns the patient is experiencing. Throughout this process, we can fulfill their needs ranging from prescription refills or broken glasses, without them having to step outside the comfort of their home.

Our office will then schedule a follow-up visit depending on the medical necessity.

How do your patients and families feel about telehealth?

I have found that many patients love telehealth! Our families feel supported and secure, since there was no interruption in their child’s care plan. I’ve also found that our families feel grateful that during this time of uncertainty, their physician was able to connect with them and address any urgent issues, and then follow them in clinic as needed.

Due to the positive response we have received from our families, we plan to continue offering telehealth appointments in the future.

Does telehealth compromise quality of care?

No. We carefully scrutinize the kind of visits that can safely be performed via telehealth without compromising on quality of care. If your ophthalmologist decides your child’s visit can safely be conducted via telehealth, rest assured your child will still receive the high level of care you’re used to receiving in person. After the telehealth appointment if we feel the need for an in-person appointment, we will work with our families to schedule that appointment promptly and safely.

Sometimes, an exam conducted via telehealth reveals something requiring an in-person appointment. In those cases, we work with our families to schedule appointments promptly and safely.

Ger more information on telehealth

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Lo que puede esperar durante una cita de telesalud

Las citas de telesalud son consultas virtuales con un proveedor de CHOC que se realizan a través de un teléfono inteligente, tableta o computadora.

Llame al consultorio de atención primaria para programar una consulta con el pediatra de CHOC.

Llame al Centro de Acceso al Paciente de CHOC al 888-770-2462 para que lo atienda un especialista de CHOC.

El proveedor de su hijo o hija decidirá si una consulta de telesalud es ideal para usted.

Después de que se programe su cita, recibirá un correo electrónico de CHOC con instrucciones.

Cuando llegue la hora de su consulta, usted y su hijo o hija pueden estar en casa o en cualquier lugar privado que tenga acceso a Internet.

También sería bueno que disponga de un termómetro, una fuente de luz y una báscula para ayudar en el examen. Además, debería conocer su laboratorio y farmacia preferidos.

Aproximadamente 15 minutos antes de la cita, usted recibirá una llamada de CHOC preguntándole si necesitara ayuda adicional para la consulta.

Para empezar, encuentre el correo electrónico de CHOC y siga las instrucciones.

Para las citas de telesalud, CHOC utiliza un software especial que cuenta con varios niveles de protección. El video de la consulta no se guardará ni se almacenará.

Durante la cita, podrá ver y escuchar a su médico o especialista. También podrá dialogar, hacer preguntas y responder las preguntas de su proveedor.

Durante la cita, podrá ver y escuchar a su médica o especialista. También podrá dialogar, hacer preguntas y responder las preguntas de su proveedora.

No se preocupe si la consulta “se siente” diferente al principio. No hay problema, eso suele ocurrir.

A los padres se les podría pedir que ayuden en el examen. Por ejemplo, es posible que usted necesite tomar la temperatura de su hijo o hija, y ayude a mostrar lo bien que él o ella puede mover sus extremidades. El proveedor lo guiará en este proceso.

Al final de su consulta, el proveedor le explicará los siguientes pasos, incluyendo el pedido de cualquier prueba de laboratorio o receta necesaria.

Este breve video describirá lo que puede esperar durante una cita de telesalud con un proveedor de CHOC Children’s.

Tips for making the most of your first mental health telehealth appointment

By Dr. Sabrina Stutz, pediatric psychologist at CHOC Children’s

Mental health services don’t always need to be carried out in person. Services can be delivered via a smartphone, tablet or computer. You and your child can engage in mental health services for telehealth from any private location with internet access.

If you are new to mental health telehealth services, here’s a guide for how you can prepare for your visit virtual appointment and what to expect, plus benefits of telehealth for mental health and answers to some commonly asked questions.

What happens before my first visit?

  • CHOC’s psychology team will email you a secure link for your virtual appointment. It is recommended that you practice signing onto the teleconference link prior to your visit.
  • We will also email a link to consent to mental health evaluation and treatment, for you to review and sign prior to your appointment.
  • We recommend that you find a place with stable internet service and good lighting in which you and/or your child can speak openly and freely with privacy.
  • Please ensure that a parent or adult caregiver will be physically present in the same location as the child at all times during telehealth mental health visits in case of emergency.

Who needs to be at the first telehealth mental health session?

Both a legal guardian and the child should be present at the beginning of the first session to go through the consenting process. It is recommended that the primary caregiver and the child be in the same physical location for the first appointment.

What will we talk about?

Your clinician will introduce themselves and confirm that a legal caregiver and child are present. They will review and confirm your contact information in the event of technology disruption or an emergency. Then, your clinician will review the consent process and answer any questions about using the teleconferencing software.

After the family consents to services, the clinician may wish to speak to the parent(s) and child separately. Your provider will review your concerns and your child’s history, and will offer feedback and recommendations/resources at the end of your visit. They will also answer any questions or concerns you may have about your child’s symptoms.

Is telehealth therapy as effective as in-person therapy?

Yes! Telehealth-delivered therapy techniques have been studied for over a decade. Many evidence-based therapies have research to prove that they are just as, if not more effective when delivered via telehealth. Cognitive behavior therapy (CBT), trauma-focused interventions, and parent-coaching models all have research to support their effectiveness when delivered online by a trained, licensed provider. Some minor adaptations can be made to ensure appropriate delivery of most evidence-based outpatient therapeutic interventions online.

What are the benefits of receiving mental health therapy via telehealth?

Telehealththerapy is a great way to access mental health services from the safety, comfort and convenience of your own home. Here are some of the other benefits of telehealth delivered therapy that families and clinicians have shared:

  • Families find it easier to attend sessions.
  • Families have flexibility in their schedule when cutting out commute time.
  • There are reduced childcare costs for untreated siblings.
  • Families save time, especially during high-traffic appointment times or when living far away.
  • Therapy is still accessible when on vacation within the state of California.
  • Children who might be nervous to do therapy feel more at ease using telehealth for a first session. Then, they are more likely to follow-up with telehealth mental health sessions afterwards.
  • Family members in separate locations can both attend a therapy session without having to be in the same location.
  • Parents at work can call in on their breaks to participate in family sessions.
  • Children and families are better able to remember and use coping skills when they have learned and practiced them in their own home environment.
  • Clinicians can see and live-coach families through difficult home-based situations like picky eating at mealtimes, setting behavioral limits such as a time out, or supporting a child in accepting a medical intervention such as  injections, pill-swallowing or nebulizers.
  • Clinicians have a richer and more nuanced understanding of families when they can see them in their home environment.
  • Clinicians can make more personalized and immediate recommendations. For example, “That looks like a great spot to put a reminder to check your blood sugar! Let’s create a reminder together and put it up during our session today.”

My child has trouble keeping their attention on the screen. What can you do for them?

The mental health community has created inventive and engaging ways to keep a child engaged over telehealth! Your clinician will talk with you and observe your child to assess their capacities for sustained attention, and can adapt interventions to fit their needs. For some children, we may ask parents to print out or set up certain activities before the therapy session to help facilitate. Other engagement strategies include share-screen therapeutic drawing and games such as Pictionary or Heads Up, gratitude scavenger hunts, “show and tell” topics, and parent-assisted relaxation exercises. If a child is unable to interact over telehealth, parent training models in which the therapist helps coach the parent to interact therapeutically with their child, are available.

How can I ensure my privacy?

 CHOC clinicians hold your confidentiality and privacy rights during telehealth sessions as seriously as they do when you come to the office. During a mental health telehealth appointment, your clinician will be in a private space where no one can see or hear them, and will be using secure, encrypted video conferencing software. We recommend that you access any mental health telehalthe services through your own password protected device on a password protected internet network to maximize your privacy. You may also wish to use headphones in order to have a more private conversation when sharing a home with others. For some very sensitive conversations, some families have chosen to step out to their cars or another more private location.

I have to work, but my child is home with another adult. Can we do a mental health visit via telehealth?

 For the first session, it is best if a legal guardian and their child can be together in the same location. Please contact your clinician for questions about special circumstances. For follow-up sessions, it will be up to you and your clinician to determine whether it is appropriate for the parent to call in from work while the child is at home with another trusted adult caregiver. Please talk to your clinician in advance of any adjustments that might need to be made for the supervision of your child during scheduled therapy sessions.

What if my child has very serious mental health symptoms?

If your clinician feels that your child’s mental health symptoms are too severe to manage over telehealth, they will review their recommendations and alternative options with you.

If you are concerned your child may be having a mental health emergency, do not wait for a telehealth mental health appointment. Instead, contact one of the crisis lines below, go to your nearest emergency department, or call 911.

  • National Suicide Prevention Lifeline: 1-800-273-8255
  • Crisis Text Line: Text HOME to 741-741
  • Orange County Crisis Assessment Team: 866-830-6011

If it becomes clear to a mental health clinician during the course of a telehealth session that your child is having a mental health emergency, the clinician will advise you to go to the nearest emergency room or call 911.

Learn more about mental health services at CHOC

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What to expect at the Thompson Autism Center during COVID-19

Changes due to COVID-19 can be stressful for everyone, but especially for children with autism spectrum disorder (ASD) and their families. Here are some tips from a CHOC psychologist on helping your child with autism understand and cope with COVID-19.

Some families may be worried about going to a healthcare facility or doctor’s office during the COVID-19 pandemic. But now, more than ever, it is important for children with ASD to stay on schedule with clinical appointments, to prevent or address physical and mental health problems.

The Thompson Autism Center at CHOC Children’s is taking extra steps to help patients continue to get the care they need safely and with minimized stress.

Safety precautions

The Thompson Autism Center has implemented the following precautions to ensure the safety and well-being of patients, families and staff and decrease the risk of spreading illness:

  • A week before, as well as the day before your appointment, you will receive a phone call from a Thompson Autism Center staff member who will ask a series of screening questions related to COVID-19 exposure. These questions may include, “Have you or anyone in your family been exposed to someone with COVID-19 in the past two weeks? Have you or anyone in your family, been sick with cough, fever, runny nose, shortness of breath or upper respiratory symptoms?
  • Please bring masks for you and your child and wear them for the duration of your time in the center.
  • We ask that only one parent or guardian accompany each patient to their appointment. A home health nurse may also attend if necessary.
  • All visitors, patients and staff are screened at the center’s front door every day, via temperature checks and questions about recent exposure and health status.
  • Additional cleaning and other protocols have been enacted to ensure safety.

To help patients cope with the changes at the center, videos are available for your child to watch when you arrive, covering topics such as how to wear a mask, how your temperature will be checked and what to expect during your visit.

We recommend that you practice wearing a mask with your child before your visit. Here are some tips from a CHOC psychologist on how to help children who are afraid of wearing masks. If you have concerns about your child and masks, please speak to their physician.

Telehealth for autism appointments

In order to minimize the number of patients and families in the Thompson Autism Center at any one time, telehealth appointments are now available for certain types of visits, such as medication checks, initial assessment appointments and other appointments as necessary. To make these appointments most beneficial for you and your child, we offer these recommendations:

  • We recommend that you use a camera-equipped desktop or laptop computer, tablet or touchpad device rather than a smartphone. This allows our providers to have a full view of your child and observe how they behave in their environment, which is a key part of autism therapy.
  • Sit in a room that can be limited to just you and your child, free from noises, distractions and other people coming in and out.
  • During the telehealth visit, we will likely spend part of the appointment without your child present, just as we do during your in-person appointment. It will be important to have a caregiver or activity available to occupy your child, allowing you to concentrate on the visit and be able to freely speak without worry of upsetting your child if you need to talk about topics that may be irritating or bothersome to them.

We appreciate your patience as we navigate the fluid environment created by COVID-19. As we implement changes, we assure you that we remain dedicated to our mission to provide your child medical, psychological and behavioral treatment as well as support for your family.

This article was updated on June 23, 2020.

Get more information on Coronavirus (COVID-19)

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Answers to your most common telehealth questions

During these challenging times, CHOC Children’s is offering parents peace of mind when it comes to caring for their children’s health and well-being. All medical care for kids is essential, including well visits, immunizations and access to specialty care. That’s why we’ve kept our offices open with additional safety measures in place and why we are offering telehealth appointments when appropriate, giving you access to our experts from your home.

We understand that many parents and families are new to telehealth, so we’ve prepared this guide of frequently asked questions on telehealth, to give parents peace of mind and help them prepare for their child’s first telehealth appointment.

What is telehealth?

Telehealth appointments are virtual visits with a CHOC provider via a smartphone, tablet or computer. You and your child can take these appointments from home or anywhere with internet access that you feel comfortable. During the appointment, you will see and hear your usual physician or specialist and will be able to interact, ask questions and answer your provider’s questions.

Are all appointments eligible for telehealth?

Primary and specialty care physicians can safely and appropriately deliver care for many conditions via telehealth technology. Some types of visits require an in-person appointment. Your child’s provider will determine if a telehealth appointment is ideal for you.

Is CHOC’s telehealth technology safe and secure?

CHOC uses a special version of Zoom, a video conferencing software, with additional layers of security to ensure the protection of our patients and their personal health information. Our telehealth platform has always been and continues to be safe.

What happens once my telehealth appointment is scheduled?

Once approved for a telehealth appointment, you will receive an email with instructions, troubleshooting tips and a link to access your video appointment. Follow the instructions. First, you’ll see a virtual “waiting room” that will instruct you to wait for your child’s physician to admit you into the appointment. Do not exit this screen. Once admitted, you will be able to see and hear your child’s provider, and they will be able to see and hear you. Make sure your child is with you so the provider can properly assess them.

Watch this video on what to expect during your first telehealth appointment and get tips for a successful telehealth appointment.

Who needs to be present?

Please ensure the patient is present for every telehealth appointment so your provider can properly assess them.

Which doctor will we see during my child’s telehealth appointment?

You will see your regular primary care physician or specialist.

What will we talk about during a telehealth appointment?

You and your child can speak with your provider about anything you would bring up during an in-person appointment. Discuss symptoms, your care plan and any questions or concerns you may have. If needed, your physician can share lab results and X-rays with you as they would in person. Your physician may ask you to help by taking your child’s temperature or by showing them a child’s rash, for example.

How much does a telehealth visit cost?

Telehealth visits are billed the same way as in-person appointments. You may be billed your standard co-pay for a visit. Telehealth visits feature your primary care physician or specialist, so you can expect the same high-quality care you’d receive at any CHOC appointment.

Do I have to have a telehealth appointment?

While telehealth may seem awkward or uncomfortable, your physician may prefer to see you via a telehealth visit so that he or she can see you sooner than they would be able to in person. If you prefer an in-person appointment, ask your pediatrician’s office or the Patient Access Center (PAC) when you call for an appointment to see if your provider is OK with waiting until the first available in-person appointment.

Ger more information on telehealth

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