Higher Education is Shaping the Future of Telehealth

When universities across the United States switched to virtual learning in the middle of the spring semester, most of them didn’t anticipate that they’d still be doing remote learning in the fall—let alone an indeterminate amount of time.

As the global pandemic rages on, higher education programs are forced to adapt to not just a new current reality but a long-term, more permanent shift to virtual education.

The landscapes of both virtual education and virtual healthcare are changing drastically. While some of those changes were a long time coming, they still require students and educators alike to be unprecedentedly nimble.

What Does School Look Like Now? 

Second-year master of social work (MSW) student at San Diego State Jordan Hartman was in the middle of her first year when the university switched to remote instruction. She’s experienced first-hand the before and after of online instruction, and the shift, she says, has been huge. 

“Before the pandemic, telehealth was never mentioned in class,” Hartman explains. “It got maybe one PowerPoint slide. It was never more than a quick mention to let us know that it exists, and can be useful for people in rural populations. Then we’d move on. And now we talk about it every day.”

Now, nearly nine months into people working and studying from home, it now seems almost unfathomable how low telehealth was on people’s radar. “Looking back,” Hartman says, “it seems crazy that it didn’t get taught more. And now, it seems like people are trying to make up for some lost time.” 

“I have professors now who bring everything back to telehealth,” she says. “We go through the lesson in the textbook and they say ‘Now here’s how this probably relates to your work right now when you see clients via telehealth.’” 

The Future of Education

There’s a difference, though, between learning about telehealth and learning via a digital platform. Distance learning isn’t a new concept. Programs with some form of correspondence course or remote learning option date as far back as the 1800s. 

Remote programs can offer significant advantages to students. For students who work full-time, have family responsibilities, or can’t live in the city a school is located in, the flexibility and affordability of online programs is compelling.

The key distinction, of course, is that instructors and students who voluntarily teach and enroll in online courses know what they’re getting into. They’ve weighed out the pros and cons of an online program, and they had the privilege to make an informed decision to go that route. 

Navigating Distance Learning Together

But for this generation’s students and teachers, the pandemic decided that they were all going to try distance learning, whether they liked it or not. And some people are still struggling to make the necessary adaptations to keep up with the challenges of online instruction. 

“You can tell no one was hoping for distance education to be the new permanent format,” Hartman says. “It’s still treated like some kind of band-aid to what we used to do. We’re just changing it a little bit to make it work just for now. A lot of the teaching methods still feel very temporary.” 

Sara Ilanit, another MSW student at San Diego State, has had similar experiences. “I have days where I pretty much sit in front of my computer camera for nine straight hours of classes,” she says. “And that’s because a lot of professors have “adapted” to online class by just giving their same three-hour lecture online. They’re not changing the format to be more conducive to the medium—like only 45 minutes of class that they supplement with other readings.”

In the spring, school switched to remote learning in the middle of a semester. Everyone was in survival mode, just trying to get through the end of year. Then, it made sense for the format of classes to be the same as when they were being taught in-person. But as the future looks like it’ll be more digital than ever before, educators and administrators must reimagine what online learning can be for years to come. 

Reckoning With the Limitations of Online Learning

Dr. Carrie Castañeda-Sound is an associate professor and the Director of the MA in Clinical Psychology program at Pepperdine University. Both in her classroom and as a program director, she’s seen the attitude toward online learning evolve, as well as the obstacles academia is facing. 

“Academics are getting a more comprehensive understanding of all the different ways that online education can happen,” she says. “For a long time, the template of what I thought online instruction looked like was asynchronous. You just posted on forums, and you never saw anyone. A few years ago, I was asked to write the curriculum for Pepperdine’s online master’s program. In the process of writing that course, I really had to look at how to transform an in-person course into something that could be done online.” 

Instructors preparing for the fall semester had to do that same examination of their courses, but in a fraction of the time and with a fraction of the resources. For Dr. Castañeda-Sound, the issue is less about changing people’s minds about online learning, and more about finding the resources and technology to help them teach effectively. 

“Developing the online masters program took a lot of resources. I had a course designer help me, and it took a lot of money and time,” she says. “Another thing we’re noticing are the limitations of technology. We’ve been asking our instructors ‘how are you replicating this certain activity,’ and we’re realizing that there’s just a lot of room for improvement in the technology, so they can do their jobs the way they need to.” 

“Even though all these video calls are ‘fake’ interactions, they’re actually forcing us to be more real with each other. And I actually love that part of telehealth.”

What Does the Future of Telehealth Look Like?

All of the issues of distance education aside, this is the reality that students and educators are in—at least for the foreseeable future. So now, their focus is on how to best serve their clients and communities to improve access to care. 

Over the past few months of lockdown, Hartman and Ilanit both have noticed an increase in the demand for mental health services. And telehealth has been the only way they’ve been able to meet that demand. 

Greater Accessibility

“We’ve noticed people reaching out more. I’m in a hybrid program, so I’m doing online and in-person visits. It’s getting harder to get online appointments,” Ilanit says. “People just need services right now. And for people without childcare or transportation, telehealth services are making it possible for them to get the care they need.” 

The increased use of telehealth has proven that accessible care is possible—and doesn’t require that much extra time or resources. Last year, Hartman worked for the Epilepsy Foundation of San Diego. She said before the pandemic, they were hosting weekly in-person support groups, seeing five to ten people attend each week. 

When the pandemic hit, those support groups went virtual. “Attendance shot up. It basically doubled overnight, which has been amazing,” Hartman says. “We have a lot of folks who have been wanting to come, but weren’t able to for whatever reason—a lot of people with epilepsy aren’t able to drive—and now all those people are able to access this resource.” 

Hartman says the foundation plans to keep offering the virtual support group even after it’s safe to be back in-person. “There’s clearly a demand for this service, so they’ll keep offering the in-person groups for folks who want that, but they’re going to keep the online groups too, so more people have access,” she explains.

A More Empathetic Workforce

By this point, probably everyone has been on a call where they can hear a coworker’s child in the background, or seen a pet walk across the screen. This is just part of the reality of working from home. Hartman and Dr. Castañeda-Sound agree that it’s also humanizing practitioners as they work with their clients. 

“You have grandmas in the background and dogs barking—and that’s all okay. It’s really humanizing. We’re all going through this together,” Hartman says. “Everyone’s still experiencing a really scary pandemic. There are going to be babies crying in the background, because we’re all doing the same thing.” 

As a parent, Dr. Castañeda-Sound has had to navigate teaching, helping her kids with school, and working with her clients. “Working from home requires a lot of flexibility and creativity anyway, but it’s a whole different story when we’re working with clients,” she says. “We feel this added pressure of ‘I need to be present all the time.’ And I think it humanizes us as clinicians, because we have to be honest with them.” 

The Need for Adaptability

That honesty between client and practitioner goes both ways. When you’re providing care to clients in their homes, what those homes might be lacking becomes a lot more apparent. Dr. Castañeda-Sound says she works with a lot of traditionally underserved populations, and many of her students go on to work in nonprofit settings. 

And although telehealth has created more equitable access to care in a lot of ways, it’s also revealing new areas of inequity that practitioners need to be aware of—and ready to make changes to accommodate for. 

“Part of what I teach my students is to think about what resources their clients have access to, and how that impacts the counseling experience,” Dr. Castañeda-Sound says. “We need to be thinking about things like, do they have WiFi? And if not, what implications does that have on their privacy? Are they going to the library or a parking lot somewhere? What impact does that have on their session?” 

Dr. Castañeda-Sound was asking these questions before the pandemic. But when looking at the future of telemedicine, they’re more important than they’ve ever been. In her view, it’ll require educators and practitioners alike to be more open-minded, and think about how they can adapt what they used to do to be successful online. 

More Honest and Direct Conversations

For a lot of practitioners, a big concern about seeing clients exclusively through telehealth is all the non-verbal cues that get missed through a computer screen. How can you watch a client walk across a room—or in Hartman’s case, as a social worker—smell if they’ve had access to a shower, or if they had a drink they shouldn’t have? 

These are real concerns practitioners in every field have, but Hartman says she’s not as worried about it as she used to be. “We had a guest speaker come in when we went remote, and his answer to all these questions about how to conduct assessments with our clients was so simple. He just said, ‘you ask them.’” 

She goes on to say, “That’s really all it is. Now you have to have conversations with your clients about these things, and you have to trust that what they’re telling you is the truth. So in a way, even though all these video calls are “fake” interactions, they’re actually forcing us to be more real with each other. And I actually love that part of telehealth. All I can go off of is what you tell me, and I think that can actually enhance the therapeutic relationship.”