Benefits and Challenges in Telehealth Service Utilization Among Foster Children in the United States: A Scoping Review

Background and purpose: Telehealth represents a promising tool to improve access to effective mental and physical health services. Since the onset of COVID-19, telehealth has been increasingly used to provide services to individuals, including children in foster care. As telehealth research and practice have rapidly emerged in this area, this study aims to synthesize the benefits and challenges of telehealth service utilization among children in foster care in the United States.

Methods: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). In December 2023, comprehensive literature searches were conducted in five databases (i.e., Embase, PsycINFO, PubMed, Social Sciences, and Web of Science) based on two concepts: foster care and telehealth. The inclusion criteria comprised empirical articles in English that examined telehealth service usage among children in foster care, as well as articles published since 2020.

Results: Our searches yielded 1,795 scholarly articles from five databases. After removing duplications and excluding articles that did not meet our inclusion criteria, we included 10 articles for review (Acri et al., 2023; Baker et al., 2023; Fortin et al., 2023; Greiner et al., 2023; Herbell et al., 2022; Langley et al., 2021; Martin et al., 2023; Cohen et al., 2021; Coon et al., 2022; Loria et al., 2021). Across articles, we identified the benefits and challenges of telehealth utilization among foster children. Regarding benefits, results suggest that telehealth was perceived as ease of use because telehealth streamlined treatment logistics, reduced transportation time and costs, and alleviated scheduling challenges. Furthermore, telehealth’s usefulness included keeping continuity with birth families for children in care, maintaining positive relationships with providers, and having increased attendance and connection. We also identified challenges at technical, behavioral, ethical, economic, and organizational levels. Technical hurdles included limited internet and virtual platform access, difficulty in navigating electronic devices, and connectivity issues. Behavioral challenges were difficulties in engaging children, building rapport, addressing short attention spans and screen fatigue, capturing behaviors, promoting child participation, overcoming preferences for in-person services, and mitigating environmental distractions. Ethical level challenges included appropriate provisions of services via telehealth, lack of evidence on the effectiveness of telehealth, and concerns about confidentiality and privacy. One challenge identified at the economic level was the reimbursement policy for telehealth services, while organizational-level challenges included placement disruptions and organizations’ low levels of integration and support for telehealth services.

Conclusions and implications: In conclusion, this scoping review has identified both the benefits and challenges of providing telehealth services to foster children in the United States. These benefits suggest the importance of expanding telehealth services while overcoming these identified challenges at technical, behavioral, ethical, economic, and organizational aspects at both macro and micro levels.