Perceptions of School-Based Telehealth in a Rural State: Moving Forward After COVID-19


  • Susan Skees Hermes Department of Occupational Science and Occupational Therapy, College of Health Sciences, Eastern Kentucky University, Richmond, Kentucky, USA
  • Jade Rauen Department of Occupational Science and Occupational Therapy, College of Health Sciences, Eastern Kentucky University, Richmond, Kentucky, USA
  • Shirley O'Brien Department of Occupational Science and Occupational Therapy, College of Health Sciences, Eastern Kentucky University, Richmond, Kentucky, USA



COVID-19, Occupational Therapy, School-based Practice, Telehealth, Telepractice, Telerehabilitation



The purpose of this study was to discern the barriers faced by school-based clinicians, chiefly occupational therapists (OTs) and speech-language pathologists (SLPs) who provided telehealth in a primarily rural state during an unexpected declaration of a state of emergency in response to the COVID-19 pandemic. Survey results found the major barriers to implementation of telehealth services to be lack of practitioner training, a lack of access to technology for students, and concerns that the quality of intervention might not be equivalent to in-person service delivery. This article discusses both the benefits and barriers to providing telehealth services in school-based practice and offers considerations for future studies on this topic.


Author Biography

Susan Skees Hermes, Department of Occupational Science and Occupational Therapy, College of Health Sciences, Eastern Kentucky University, Richmond, Kentucky, USA

Susan has over 36 years of clinical experience working with all ages and populations. Her expansive areas of practice include mental health, inpatient rehabilitation,  school based, home health, outpatient, skilled nursing settings, management, education, and consulting. Besides multiple volunteer team roles in the American Occupational Therapy Association; she also has been in leadership roles in Texas and Florida state occupational therapy associations. She joined the Eastern Kentucky University as full-time faculty this year.  Her current research interests include: school-based collaborative practice, occupational therapy professional development in the People’s Republic of China, IPC & intergenerational care and learning programs, occupational therapy’s role in disaster and emergency planning, Kentucky school based telehealth practices, and professional association leadership development.


American Occupational Therapy Association. (2018). Telehealth in occupational therapy. American Journal of Occupational Therapy, 72(2),7212410059.

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of Practice].

Brennan., D., Tindall, L., Theodoros, D., Brown, J., Campbell, M., Chirstiana, D., Smith, D., Cason, J., & Lee, A. (2010). A blueprint for telerehabilitation guidelines. International Journal of Telerehabilitation, 2(2), 31-34.

Cabinet for Health and Family Service. (2020). Telehealth Program. https://govstatus://

Camden, C., & Silva, M. (2021). Pediatric telehealth: Opportunities created by the COVID-19 and suggestions to sustain its use to support families of children with disabilities. Physical & Occupational Therapy in Pediatrics, 41(1), 1-17.

Campbell, J., Theodoros, D., Hartley, N., Russell, T., & Gillespie, N. (2019). Implementation factors are neglected in research investigating telehealth delivery of allied health services to rural children: A scoping review. Journal of Telemedicine and Telecare, 26(10), 590-606. 26

Cason, J. (2012). An introduction to telehealth as a service delivery model within occupational therapy. OT Practice, 17(7), CE1-CE8.

Cason, J., & Cohn, E. (2019). Ethical considerations for client-centered telepractice. ASHA Wire, 4(4), 704-711.

Cason, J., & Jacobs, K. (2014, August 11). Snapshots of current telehealth applications in occupational therapy. OT Practice, 19(14), 7-12.

Clark, G. F., Fioux, J. E., & Chandler, B. E. (2020). Best practices for occupational therapy in schools (2nd ed.). AOTA Press.

Cohn, E. R., & Cason, J. (2019). Clinical focus: Ethical considerations for client-centered telepractice. Perspectives, 4(4), 704-711.

Creswell, J., & Creswell, J. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.) Sage Publications, Inc.

Criss, M. (2013). School-based telerehabilitation in occupational therapy: Using telerehabilitation technologies to promote improvements in student performance. International Journal of Telerehabilitation, 5(1), 39-46.

Dahl-Popolizio, S., Carpenter, H., Coronado, M., Popolizio, N. J., & Swanson, C. (2020). Telehealth for the provision of occupational therapy: Reflections on experiences during the COVID-19 pandemic. International Journal of Telerehabilitation, 11(2), 77-92.

Ferguson, J., Craig, E.A., & Dounavi, K. (2018) Telehealth as a model for providing behaviour analytic interventions to individuals with autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 49, 582–616.

Fischbach, J. (2019). Best practices in providing telehealth to support participation. In G. Frolek Clark, J. E. Rioux, & B. E. Chandler (Eds.), Best practices for occupational therapy in schools (2nd ed.). AOTA Press.

Individuals with Disabilities Education Act, 20, U.S.C §1400U (2004). U. S. Department of Education.

Johnsson, G., Kerslake, R., & Crook, S. (2019). Delivering allied health services to regional and remote participants on the autism spectrum via video-conferencing technology: Lessons learned. Rural and Remote Health, 19(3), 5358.

Jones, A. M., Shealy, K. M., Reid-Quinones, K., Moreland, A. D., Davidson, T. M., Lopez, C. M., Barr, S. C., & de Arellano, M. A. (2014). Guidelines for establishing a telemental health program to provide evidence-based therapy for trauma-exposed children and families. Psychological Services, 11(4), 398–409.

Kentucky Department of Education. (2019). School closings.

Little, L. M., Pope, E., Wallisch, A., & Dunn, W. (2018). Occupation-based coaching by means of telehealth for families of young children with autism spectrum disorder. American Journal of Occupational Therapy, 72(2), 7202205020.

Love, H., Panchal, N., Schlitt, J., Behr, C., & Soleimanpour, S. (2019). The use of telehealth in school-based health centers.

Nissen, R. M., & Brockevelt, B.L. (2016). The effect of education on student perceptions about telehealth. International Journal of Health Sciences, 4(4), 5–10.

O'Brien, S. P. (2017). Faculty perspectives of teaching online. In S. Thompson & P. Parry (Eds.), Coping with Gender Inequities (pp. 43-56). Rowman & Littlefield Publishing Group.

Pecini C, Spoglianti S, Bonetti S, Di Lieto MC, Guaran F, Martinelli A, Gasperini F, Cristofani P, Casalini C, Mazzotti S, Salvadorini R, Bargagna S, Palladino P, Cismondo D, Verga A, Zorzi C, Brizzolara D, Vio C, Chilosi AM. (2019). Training RAN or reading? A telerehabilitation study on developmental dyslexia. Dyslexia, 25(3), 318-331.

Ritchie, C. L. W., Miller, L. L., & Antle, D. M. (2017). A case study detailing key considerations for implementing a telehealth approach to office ergonomics. Work, 57(4), 469–473.

Rortvedt, D., & Jacobs, K. (2019). Perspectives on the use of a telehealth service-delivery model as a component of school-based occupational therapy practice: Designing a user-experience. Work, 62(1), 125–131.

Sanchez, D., Reiner, J. F., Sadlon, R., Price, O. A., & Long, M. W. (2019). Systematic review of school telehealth evaluations. Journal of School Nursing: The official publication of the National Association of School Nurses, 35(1), 61–76.

Schaaf, R. C. (2015). Creating evidence for practice using Data-Driven Decision Making. American Journal of Occupational Therapy, 69, 6902360010.

Shisley, S. (2020, May 20). Emergency remote learning compared to online learning. Learning Solutions.

Smith, A. C., Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). International Journal of Telerehabilitation, 25(5), 309-313.

Smith-Foley, S. (2020, September 9). Considerations when moving school-based sensory interventions to telehealth. OT Practice, 25(9), 26-28.

Tenforde, A.S., Borgstrom, H., Polich, G., Steere, H., Davis, I. S., Cotton, K., O’Donnell, M., & Silver, J.K. (2020). Outpatient physical, occupational and speech therapy synchronous telemedicine: A survey study of patient satisfaction with virtual visits during the COVID-19 Pandemic. American Journal of Physical Medicine and Rehabilitation, 99(11), 977-981.

van Houwelingen, C.T.M., Ettema, R.G.A., Bleijenberg, N., van Os-Medendorp, H., Kort, H. S. M., & ten Cate, O. (2020). Educational intervention to increase nurses’ knowledge, self-efficacy and usage of telehealth: A multi-setting pretest-posttest study. Nurse Education in Practice, 51, 102924.

Wallisch, A., Little, L., Pope, E., & Dunn, W. (2019). Parent perspectives of an occupational therapy telehealth intervention. International Journal of Telerehabilitation, 11(1), 15-22.

World Population Review. (2021). Cities in Kentucky.




How to Cite

Hermes, S. S., Rauen, J., & O’Brien, S. (2021). Perceptions of School-Based Telehealth in a Rural State: Moving Forward After COVID-19. International Journal of Telerehabilitation, 13(1).



School Telepractice