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Teletherapy Case Study

Star of CA Telehealth during Covid-19

Teletherapy Case Study

The Quick Pivot to Telehealth for Behavioral and Mental Health Services


Executive Summary:

Across the country in mid-March, Federal, state and local governments began grasping the realities of the COVID-19 pandemic. The Federal government began passing legislation to buffer the coming economic calamity, governors issued stay-at-home advisories and local governments shuttered public schools. STAR of CA (STAR), a provider of home, community, and school-based Applied Behavioral Analysis (ABA), and mental health services, experienced the initial shock of its clients no longer receiving services in the traditional school setting and families becoming increasingly uncertain about in-person services being delivered in their homes. In response, STAR developed an immediate action plan to continue delivering legally mandated and clinically necessary ABA and mental health services to its home, community and school-based clients. A key part of STAR’s approach was the rapid introduction of a telehealth solution for ABA and mental health services to ensure that children, adolescents, and their families had the best opportunities to stay on track during this period of disruption. Now one month into the stay-at-home advisories, 77% of STAR’s active clients are receiving telehealth.


COVID-19: The Challenge for STAR to Deliver Home, Community and School-Based ABA and Mental Health Services

 As a result of emergency home sheltering orders imposed by state and local governments, public and private schools across the country were closed, preventing millions of students from accessing the traditional in-person ABA and mental health services on which they rely. Further, many parents and families exercised caution with regard to continued in-home and community services. In response, the U.S. Department of Education, state health and education departments and regulators, and state license boards took rapid action to provide guidance on telehealth as an alternative service modality and to relax the enforcement of HIPAA guidelines. Emergency guidance was provided by commercial and Medi-Cal insurance payers, Regional Centers and school districts regarding clinical, administrative and payment guidelines for telehealth services. Based on this guidance, STAR immediately began to work closely with its payers and clients to implement telehealth solutions.


The Pivot to Telehealth Services

Prior to COVID-19, STAR utilized telehealth modestly as a supplement to case supervision needs for ABA services whereby a Board Certified Behavioral Analyst (BCBA) in a remote site could provide either supervision and clinical direction to a Behavior Technician (BT) in the intervention setting administering direct ABA therapy, as well as parent/caregiver education to family members when in-person visits could not be delivered.

While the clinical efficacy for supervisory ABA and mental health services delivered via telehealth is generally consistent with in-person delivery, there is a clear preference by insurance payers, children, and parents for face to face services that take place in the intervention setting. With COVID-19 all but eliminating in-person mental health and behavioral services, the “last resort” telehealth option became the essential tool to continue care for clients and their families. The STAR team believed that a virtual service delivery model could be implemented quickly with limited interruption in services.

STAR developed a telehealth solution that allows the provision of ABA and mental health services to continue for clients and families in their homes using a secure video-conferencing platform. STAR utilized its pre-existing technology infrastructure, Lifesize.com, as its cloud-based videoconferencing and telehealth solution. Lifesize is a HIPAA compliant software and application that is downloaded to iPads and iPhones issued to clinical staff including Behavior Technicians, Board Certified Behavioral Analysts, Mental Health Associates and Mental Health Clinic Leads. STAR’s employees already had familiarity with the platform, smoothing the transition for both families and clinicians.

Every STAR department mobilized rapidly to support telehealth, implementing several training and staff development initiatives to prepare clinical staff for the effective use of the telehealth platform on a larger scale. The STAR Clinical Leadership team established practice standards, protocols, and guidelines for the use of telehealth. Certain STAR clinical team members with telehealth experience were designated as subject matter experts to assist with answering clinical telehealth questions.

STAR’s operations team also ensured that clinical staff had access to all appropriate technology tools, developed and administered training tools, and provided guidelines on best practices and frequently asked questions to therapists, clients, parents, and guardians.


Maintaining Quality Services and Customer Service During COVID-19

Leveraging STAR’s telehealth solution allows clients to continue receiving ABA and mental health services to stay on track and progress toward their goals. Procedures are in place to colle ct the required documentation and data, as well as to coordinate scheduling and consent forms with client families. With these tools, and STAR’s operational infrastructure and support, clients can continue to progress as expected despite not receiving services in person. STAR is able to offer these telehealth services at no additional cost to the insurance, regional center, school district payers or clients.

STAR is committed to providing telehealth technical training, clinical training, resources and ongoing support to its home, community and school-based partners as the company continues to pursue its mission of transforming lives together during this unprecedented time.

STAR of CA is part of The Stepping Stones Group, a leading provider of therapeutic and behavioral health services to children including those with special needs and autism.


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