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Telepsychiatry: Increasing Access to Care for Children and Adolescents

     

The use of telemedicine, providing care remotely via videoconferencing, has grown significantly in recent years, partly because of increasingly available, effective and affordable technology. The trend includes providing care to younger patients.

Overall, the need for mental health services for children and adolescents is great—about 20 percent of children and youth have a diagnosable psychiatric disorder. Most children and youth with mental health issues do not receive care. Telepsychiatry may help more people, especially those in rural or remote areas, access the psychiatric care they need.

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While the idea of talking with a psychiatrist on a screen may seem a bit awkward or impersonal, research on the use of telepsychiatry for children and adolescents has found that parents and teens are satisfied with these services and it is effective. For some, it may be easier to participate from a comfortable, familiar setting. Also, telepsychiatry may be particularly suited for some children and teens because they’re more familiar and comfortable with the technology.

A recent clinical update on telepsychiatry in the Journal of the American Academy of Child and Adolescent Psychiatry (AACAP) notes that current research, though limited, has shown outcomes are comparable to in-person treatment. 1

Connecting at home or in a clinic, school or other setting

Child and adolescent telepsychiatry services can be provided directly to patients or through consultation and are offered in a number of settings. Psychiatrists can provide care, via a videoconference, in individual’s homes or in a primary care or other health care facility. They can conduct evaluations, manage medications, provide psychotherapy and provide training for parents on behavior interventions.

Psychiatrists also consult with pediatricians or other primary care providers who are often first to be aware of potential mental health challenges. Offering mental health services in a primary care setting, either directly or through consultation, can make it easier for people to get to an appointment and may carry less stigma than services in a separate mental health care clinic or office.

Telepsychiatry services are also used at schools where psychiatrists provide evaluations for support services, continuing education for school staff, consultation on classroom and school issues, and support in coping with specific incidents such as natural disaster or violence. Psychiatrists also provide services remotely in emergency departments where mental health challenges are common and psychiatric services, especially for children and youth, are typically not available.

Insurance and Procedures

As of 2017, 31 states and the District of Columbia require private insurance plans to cover telehealth services and all states provide for some reimbursement for telepsychiatry through Medicaid. 1

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From a technology perspective, the process is becoming easier and more efficient. According to AACAP, many telepsychiatry programs are transitioning to HIPPA*-compliant cloud videoconferencing, allowing participants to easily connect using a computer, tablet or smartphone.

For managing medication, a psychiatrist may work directly with patients and families or work with a pediatrician or with another mental health providers (such as a psychologist). General prescriptions may be sent to the local clinic or provided by a collaborating primary care provider or sent directly by the psychiatrist to the family or nearby pharmacy. Controlled substance prescriptions (including most ADHD medications) have additional federal and state requirements.

Some issues to consider or clarify is you’re considering seeking treatment with a psychiatrist remotely:

  • Procedures for prescriptions and refills
  • Back-up procedures in the event of technical problems
  • Space considerations (such as a room with enough light, large enough for child and adult to be onscreen and not too noisy)
  • Plan for addressing potential urgent needs or emergencies
  • Psychiatrists’ availability between appointments

Help for Patients & Families

Learn about common mental disorders, including symptoms, risk factors and treatment options. Find answers to your questions written by leading psychiatrists, stories from people living with mental illness and links to additional resources.

Learn More

References and Resources

  1. American Academy of Child and Adolescent Psychiatry (ACAAP). Clinical Update Series: Telepsychiatry with Children and Adolescents, Journal of the American Academy of Child and Adolescent Psychiatry (2017), doi: 10.1016/j.jaac.2017.07.008
  2. Khan, Shabana. Current Trends in Child and Adolescent Telepsychiatry. American Psychiatric Association Telepsychiatry Blog. July 20, 2017
  3. Parekh, Ranna. Child and Adolescent Telepsychiatry. American Psychiatric Association.

*HIPAA, the Health Insurance Portability and Accountability Act, is U.S. law that provides data privacy and security provisions for safeguarding medical information. More from the US Department of Health and Human Services at https://www.hhs.gov/hipaa/for-individuals/index.html

     

AnxietyDissociative DisordersADHDBipolar DisordersIntellectual DisabilitySleep DisordersDepressionAutismPatients and FamiliesGender DysphoriaOCDPersonality DisordersEating DisordersSpecific Learning DisorderAddictionPTSD

 

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