Table 1.

| Key practice and policy challenges and responses resulting from the transition to virtual delivery of services within a pediatric diabetes behavioral health program

Challenges	Response
Practice
Practitioner level
Ethical, clinical, and legal dilemmas in providing telehealth to patients with safety concerns	Discussed privacy measures and confidentiality up front and throughout treatment Obtained and documented consent for each telehealth visit Obtained patients’ physical address at the time of the session, nearest emergency room, and primary and emergency contact information Created communication plan for technological difficulties
Barriers to providing behavioral health consultations to patients during routine diabetes medical appointments Inclusion of challenges and impact of COVID-19 in individual and group treatment	Conducted consultations via telehealth following medical visits (with some delay for coordination of session) Adjusted session content to include COVID-19 topics related to stress, communication, coping strategies, and diabetes management
Patient level
Managing behavior and maintaining engagement virtually	Provide developmentally tailored socialization to telehealth Incorporate visual aids, as well as creative and movement-based activities
“Digital divide”: youth from disadvantaged backgrounds have less access to technologies	Advocacy for expansion of high-speed internet access to rural and underserved communities Provide families with physical resources and digital literacy skills needed to engage with telehealth Ensure accessibility to interpretation services for telehealth with families from non-English speaking backgrounds
Policy
Providing services in multiple jurisdictions, with little or no prior notice	Advocacy for a national licensure credential or portability of licensure status across state lines to allow clinicians to broaden access to care
High financial burden of maintaining multiple state licenses	Institutional provision of necessary technological and financial supports to encourage continuation of telehealth
Insurance carriers may end telehealth reimbursement coverage for mental health visits during or following COVID-19	Incorporate reimbursement of telehealth into standard benefits for policy holders