Telehealth ROCKS at Home: Pandemic Transition of Rural School-Based to Home-Based Telebehavioral Health Services

School-based telebehavioral health is one avenue to increase students' access to mental health services, especially for students who are less likely to access traditional community mental health settings due to a lack of transportation to distant sites, financial resources, and other barriers. With the shortage of child behavioral specialists in Kansas' rural and underserved communities, the Telehealth ROCKS (Regional Outreach to Communities, Kids, and Schools) program was created to address student behavioral health needs at school through telehealth. Since 2018, this program has provided approximately 1,600 mental health appointments. With public health mandates and a shift to online school, the COVID-19 pandemic led to a rapid telehealth transition from services in rural supervised school settings to direct-to-consumer services in homes. The authors describe the challenges and opportunities experienced during this transition across telebehavioral health specialties: (a) developmental/autism assessments, (b) developmental behavioral interventions to address problem behaviors, (c) child and adolescent psychological services, (d) medical complexity services, and (e) child and adolescent psychiatry. The authors then describe the overall transition from school-based to home-based services based on national Guidelines for Evidence-Based Child Telebehavioral Health domains: Patient Appropriateness, Crisis Management/Safety, and Logistics/Administrative Protocols. This experience and lessons learned can inform other school-based telemental health programs considering expansion to home-based services. The authors also discuss evolving telehealth policy and the reimbursement environment, with continued relevance due to continued COVID-19 outbreaks impacting school services and future public health emergencies affecting schools. Public Health Significance Statement This report shares lessons learned when rapidly transitioning the Telehealth ROCKS rural telebehavioral health services from the supervised school setting to the unsupervised home setting during the COVID-19 pandemic to meet escalating student behavioral health needs.