Bridging the Gaps in School-Based Telehealth: A Scoping Review and Evaluation Framework

Objectives: This scoping review aimed to characterize the implementation of telehealth interventions in U.S. K–12 school settings, map how their performance and outcomes have been evaluated across a standardized evaluation taxonomy, and develop a conceptual framework to address gaps in evaluation practice. Methods: We conducted a scoping review following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines, searching PubMed, CINAHL, Scopus, and Google Scholar for studies published between January 2019 and April 2026. Two reviewers independently screened records and extracted data on study characteristics, intervention types, and evaluation domains. Measures were classified into a standardized taxonomy and synthesized using descriptive mapping and frequency analysis. Framework development was iterative and informed by extracted findings, conceptual review, and integration of existing implementation and evaluation models, alongside policy guidance relevant to school-based telehealth (SBTH). Results: A total of 1,217 records were identified, with 22 studies meeting the inclusion criteria. Studies were heterogeneous across service lines and methodologies. Evaluation most frequently focused on access and utilization, satisfaction or acceptability, and implementation outcomes, while health outcomes, cost, academic outcomes, and sustainability were less consistently assessed. Evaluation approaches were fragmented, with limited use of standardized metrics and minimal integration across domains. These findings informed the development of a structured framework spanning Inputs, Implementation Processes, and Outcomes, capturing the relationships between contextual factors, service delivery, and multidimensional performance indicators. Conclusion: SBTH appears feasible, acceptable, and capable of improving access to care; however, fragmented evaluation practices limit comparability and policy translation. The proposed framework provides a structured approach to guide comprehensive, longitudinal evaluation and support scalable, integrated telehealth implementation in school settings.