Teletherapy Through Pandemic and Beyond

By Erica Bates, Vice President of Services, Minds Matter, LLC

Kansas has creatively implemented Medicaid home- and community-based service (HCBS) waivers for decades. Specifically, the brain injury (BI) waiver provides rehabilitative and habilitative services to Kansans that have an acquired brain injury.  The waiver’s intent is rooted in independent living philosophy and offers intensive rehabilitation; including physical, occupational, speech, cognitive, and behavioral therapies.

Consumers lead their therapy teams and develop person-centered goals geared toward independence. Independent living goals range from transferring and dressing to grocery shopping, employment, driving, and having meaningful relationships. Historically, services have been provided with the therapists physically present in the consumer’s home or community. Community-based rehabilitation not only offers an easy generalization of compensatory strategies, but increases social capital and community involvement.

Despite the cumulative efforts of researchers, disability advocates, and policymakers, consumers in some areas of the state continued to access the waiver without rehabilitation due to a lack of providers, specifically in rural areas.  In response to COVID-19, therapies can now be provided using teletherapy. Therapists engage consumers in rural areas previously void of services.  

Given the novelty of this method of service delivery on our HCBS waiver, an assessment of effectiveness, consumer satisfaction, and provider perspective was needed. Two nearly identical surveys were distributed to 200 individuals (n=86 respondents, 30 consumers, and 56 providers). The first group surveyed was comprised of BI waiver participants that had utilized teletherapy and the second group contained rehabilitative therapists that had provided services using teletherapy on the BI waiver.

Here are some of the findings:

• 70% of respondents agreed or strongly agreed the technology was reliable and easy to use.
• 76% agreed or strongly agreed to being satisfied with services
• 83% agreed or strongly agreed with teletherapy being an effective method of service delivery

Providers and policymakers have been questioning the effectiveness of tele-video versus telephonic intervention. 66.66% of respondents reported telephonic intervention as being effective in contrast to 83.33% of respondents describing tele-video intervention as effective. Interestingly, consumers found telephonic sessions to be approximately 14% more effective than providers. This is an important factor to consider as not all participants have internet access or an electronic device to use for tele-video.

The combined responses of consumers and providers suggest that not all therapies are equally suited for teletherapy. They ranked cognitive therapy as most effective followed by speech therapy, behavioral therapy, occupational therapy, and then physical therapy.

Open-ended feedback provided by survey respondents indicated in-person service delivery is strongly preferred, but teletherapy is a good alternative when community-based sessions aren’t an option. They specifically noted use during the pandemic, inclement weather days, and accessing remote areas of the state.

Stakeholders are interested in making teletherapy a permanent method of service delivery. During the last 30 years, the BI waiver has supported Kansans to live their lives the way they want following a life-changing disability. Although teletherapy is unchartered territory, stakeholders can work together to ensure independent living and person-driven services no matter how therapy is provided.

About the Author

Erica Bates is the vice president of Services with Minds Matter, LLC, and completed this program evaluation with their support. Minds Matter believes that people with brain injuries and their families are the experts in their own lives. Rehabilitation plans and decisions are made with the person at the center of the process. Teams then collaborate with the person and chosen family to create meaningful connections in their community. A functional rehabilitation approach is designed to give control back to the person by listening, understanding, and responding so they can live their lives, their way. This model has impacted the lives of thousands of consumers and is able to be replicated in communities across the globe.