School-Based Tele-Physiatry Assistance for Rehabilitative and Therapeutic Services

During this study, a novel model of care will be developed and tested using telehealth
technologies to bring necessary medical expertise to children with special health care needs
living in rural and underserved communities. This model of care will be implemented in eight
school-based Medical Therapy Units (MTUs) in northern California using a randomized design.
The investigators hypothesize that this model of care will result in 1) equal satisfaction of
the care received in-person from pediatric physiatrists and increased satisfaction of the
care received from non-pediatric specialists; 2) equal adherence rates to an evidence-based
hip surveillance program when compared to children who receive care from in-person pediatric
physiatry care and better adherence than children who receive care from non-pediatric
specialists; and 3) cost savings when compared to medical direction provided in-person by
pediatric physiatrists and non-pediatric specialist providers.

The first 6 months of the project will be a "ramp-up" period during which the protocol will
be re-reviewed during MTU site visits and necessary contracts and approvals will be in place.
The last 6 months will be reserved for data analysis, study closeout, and manuscript
preparation. The intervention phase will include various designs of implementation. For those
schools currently without pediatric physiatry services, the investigators will provide MTU
services using telemedicine and add in-person clinics. For those schools where medical
direction is provided by non-pediatric physiatrists, the investigators will augment current
services using telemedicine to provide medical direction to some children using pediatric
physiatrists. For those schools where pediatric physiatrists travel long distances to provide
medical direction during scheduled clinics, the investigators will similarly add additional
telemedicine services such that an augmented mixed model of in-person and telemedicine
pediatric physiatrist medical direction will be provided.

Inclusion Criteria:

- Participants will include children with special health care needs enrolled in the CCS
Medical Therapy Program receiving care at one of the participating sites during the
study period.

Exclusion Criteria:

- Children with special health care needs not enrolled in the CCS Medical Therapy
Program.