By: James Varrell, M.D.
Originally published on Arizona Telemedicine Program
As a child and adolescent psychiatrist practicing in person for a number of years, and eventually making the shift to telepsychiatry, I have observed the subtle differences and nuances between the two mediums of care.
In my experience, telepsychiatry can be particularly powerful when working with children and teens. I had one experience with a 15-year-old adolescent who was admitted to the hospital for the fourth time with continued severe abdominal pain that could not be attributed to a medical cause. The hospital staff was puzzled, as the diagnostic tests did not show any signs of ailments and there were no physical afflictions present in the child. Interestingly enough, the teen had already been evaluated by another psychiatrist at the hospital, who was unable to get the teen to “open up.”
However, a caring on-site staff member had noted the teen admired technology. She recommended that the telemedicine cart that was normally used in the ED be brought up to the teen’s room to connect him to a telepsychiatrist who specializes in child and adolescent psychiatry. It was clear he felt much more at ease talking with me on a screen than he had been talking with his in-person providers. During our session, I was able to leverage his interest in technology, as well as my child and adolescent psychiatry experience, in order to ease his reservations about sharing his story. I found that in the past the teen had seen his brother shot in the stomach, causing psychological trauma that resulted in his abdominal pain.
Just as my experiences have shown, the effect of technology on children in a clinical setting has been researched and shown to have positive impacts in a number of ways. In one study, adolescents reported that telemedicine promoted a transfer of power and control by allowing them to feel more comfortable with terminating a consultation or walking out of it, that the process is more structured, and that the adolescents feel better informed when speaking with a telepsychiatry provider, which can result in a better understanding, sense of shared responsibility and better decision making.
Although telepsychiatry is almost identical to in-person psychiatry, there are small adaptations providers can make to facilitate responses, especially in the case of special populations, including children and adolescents. Provider flexibility is often the key to success. Slowing down your speech, communicating with gestures and remembering to not infantilize your speech when evaluating children can all contribute to establishing a more effective patient-provider relationship. I educate other telepsychiatrists about games they can play and questions they can ask to encourage children to interact with them more freely. It can also sometimes be beneficial to involve a child’s parents or an on-site facilitator in the session to observe interactions. These tactics have helped me gain trust and encourage meaningful responses from children I have treated through telepsychiatry.
In the case of the boy with stomach pain, instead of providing continued costly and time-consuming medical intervention, we were able to get him the appropriate psychiatric treatment after our conversation.
The best care, especially for children, adapts to the preferences and needs of each individual. Telemedicine is a fantastic tool for increasing specialty care options and making sure that every person can access the right provider and the right type of care for them.
By Jeanine Miles, LPC
Original article posted on NAMI
Unprecedented need exists for child and adolescent mental health services in today’s communities, however, parents have limited options at their disposal. Shortages of child psychologists and psychiatrists are leaving our most vulnerable populations without care. Currently, all U.S. states are facing high or severe shortages, with many communities lacking even one qualified child and adolescent psychiatrist.
We need an effective solution, and it might be telebehavioral health. This convenient, accessible model of care has been gaining traction: Studies consistently reveal high satisfaction rates for children, adolescents and parents, often reaching above 90%. In fact, a 2013 study determined that telebehavioral health might be better than in-person care for children and adolescents because this age group often expresses an unwillingness or reluctance to participate in traditional therapy sessions.
Telebehavioral health might be a natural solution for improving access to care, but that’s just one benefit. As a counselor who offers telesessions, I’ve seen many more. Consider the following:
Clinical office settings often intimidate children and adolescents. I find that younger populations are more willing to open up when they are in their own environment surrounded by familiar possessions or in reach of pets who may offer comfort. With telebehavioral health, I also get clues and information from a home environment I never see in an office setting.
For example, one child was well-behaved during our traditional office appointments. Yet her mother described a very different child with erratic behaviors while at home. Through our telebehavioral health sessions, I could see family interactions that confirmed the mother’s assessment. I was then able to teach the young girl and her family healthy coping techniques right there “at home.”
Familiar Modes Of Communication
Younger generations have grown up with technology. In fact, a 2015 study shows 67% of teens own a smartphone and spend more than four hours daily engaged with it. Videoconferencing, therefore, is a natural fit for today’s youth. Many teens prefer telesessions compared to traditional office sessions because it’s familiar and helps build trust. Simply put: Today’s youth are more comfortable communicating through a screen.
One of the greatest barriers to engaging younger populations in mental health treatment is stigma. Many adolescents fear their peers will find out they go to therapy and ask questions. Professional shortages and scheduling challenges often causes students to miss school to attend therapy sessions. When a student leaves school early or checks in late, their peers may ask questions or make them feel uncomfortable.
With telebehavioral health, scheduling becomes much easier, as sessions can take place outside of traditional office hours. Patients do not have to miss school, nor do they run the risk of running into someone they know in a waiting room.
When choosing a telebehavioral health care organization or provider for your child, it’s important to do research before pursuing treatment. Things to consider are whether or not they are HIPAA-compliant, if they offer technical or care navigation support, whether they have providers licensed in your state, and if you can pay with your insurance plan. A good place to start is a reference guide, such as the one created by Open Minds that lists reputable telebehavioral health organizations.
Telebehavioral health care is changing the way communities and families approach mental health services. At a time when the need for mental health care is soaring, this option holds great promise for addressing gaps in care and providing parents with a critical resource for addressing their child’s health and well-being.
Jeanine Miles, LPC, Cognitive Behavioral Therapist with Inpathy and the Director of Business Development and Training at the Center for Family Guidance. Jeanine is a New Jersey Licensed Professional Counselor and has over 20 years of administrative and management experience in healthcare and behavioral healthcare. She is responsible for the development and implementation of new programs including overseeing all start-up projects, social skills training and school based programs. Jeanine has provided therapy and other telebehavioral health services through Inpathy since the program was launched and has long been an advocate for telebehavioral health.