Behavioral health providers have been utilizing telehealth for some time now, but one particular group has demonstrated an especially positive impact—our children.
There is some preliminary evidence that videoconferencing offers advantages for the youth and adolescents, including less self-consciousness, increased personal space, and decreased confidentiality concerns as the provider is outside of the local community. Telehealth may be especially suited for youth who are accustomed to the technology, especially adolescents who may respond to the personal space and feeling of control allowed by videoconferencing.
Multiple studies have demonstrated the feasibility of implementing telemental health services with young people across diverse settings. Diagnostic assessments have been reliably conducted through videoconferencing for youth with various disorders evaluated in outpatient settings including disruptive behavior disorders, autism, and other developmental disorders, and psychotic disorders.
Currently, the point of delivery for telemental health services is as varied as the type of services that are being provided: primary care clinics, community mental health centers, physician offices, outpatient clinics. There are also other settings that are starting to utilize telehealth to support behavioral health issues such as schools, correctional facilities, residential treatment facilities, critical access hospitals, group homes, sites serving foster care, military bases, and daycares.
How Telehealth Improves Mental Health in Community Settings
Clinics & Offices
There is a long history of moving mental health care for youth from the mental health clinic to the community to improve access to care, increase adherence to treatment planning, and to provide services in naturalistic settings. Consistent with this pattern, telemental health services are being moved outside of traditional mental healthcare settings. When telemental health services are implemented in community settings, they offer the opportunity to ascertain contextual factors involved in youths’ behavior and mental health needs, as well as to involve stakeholders in youths’ care and outcomes. In particular, telemental health offers a powerful opportunity for collaboration with pediatricians to help them address the increasing expectations to improve their skills in diagnosing and managing common mental health conditions of young people. Pediatric telepsychology has shown feasibility in overcoming some of these challenges when providing services during medical visits or at home.
School-based telemental health services engage youth during the school day thereby reducing distances youth must travel to a clinic, decreasing missed school days, disruption in the child’s classroom time and parent’s workday, allowing parents to be involved in a setting that is familiar and convenient, and incorporating school personnel into treatment planning. Telehealth allows the youth’s provider to be efficiently involved in multidisciplinary planning, student evaluation, Individualized Education Plan meetings, and collaboration with teachers, school specialists (e.g., school psychologists, social workers, and allied health specialists), nurses, and administrators.
Examples of services that may be delivered by the provider to the school system include mental health evaluations, behavioral interventions, medication treatment, ongoing sessions with students and families, evaluation for support services, continuing education for staff, and consultation on both classroom specific and general school issues and consultation in the event or threat of an event that may adversely impact the school community (e.g, the untimely death of a student or teacher, natural disaster, etc).
Another area of school-based telemental health is the delivery of educational support services, such as counseling, occupational therapy, or speech therapy, to youth who are home-bound or as a means to continue services when school is out of session.
Treatment & Correctional Centers
Residential treatment centers and correctional settings often require prolonged separations of families from a youth who is confined in a facility far distant from family and provider. Telemental health allows families to participate in a youth’s treatment while remaining in their home communities or telecommute a mental health specialist to the youth’s facility. For example, the multipoint capabilities of telemental health can deliver multi-systemic therapy, which includes a network of caregivers, school officials, peers, and neighbors to promote positive behavioral changes. Delivering telemental health services to such facilities provides challenges to privacy and confidentiality. Home-based telemental health offers potential advantages to observe the youth in a naturalistic setting and to practice skills in the lived environment.
Some facilities are delivering behavioral interventions for early-onset behavior disorders such as obsessive compulsive disorder (OCD). They use videoconferencing to observe the youth’s behavior and then to guide parents in facilitating behavioral interventions.