•  Telepsychiatry with Children and Adolescents in Community Mental Health Settings
•  Lynda Lee Carlisle, M.D., DFAACAP

• Federal mandates that have increased the eligibility of children and adolescents for mental health care have not comparably increased the capacity for services.
• In non-metropolitan communities, youth often receive their mental health care at community mental health centers. Child and adolescent telepsychiatrists can provide the psychiatric services that are not available locally.
• There is often a wide variety of staff specialists at community mental health centers, and they may not be child-trained. Many are not yet licensed, or are working toward advanced degrees. Child and adolescent telepsychiatrists may play an important collaborative role to upgrade evidence-based, child-specific services and bolster support networks.
• Psychiatrists providing telepsychiatry to rural areas can help to build capacity and bridge the access-to-care gap by referring youth back to their primary care provider for medication management after evaluation and/or stabilization. This collaboration can open telepsychiatrists' schedules more quickly to increase access and provide a resource for primary care providers.
• Staff and administrators at community mental health centers may need some education to learn how to work remotely with psychiatry, to appreciate its benefits, and to overcome limitations.
• Child and adolescent telepsychiatrists must learn how to work within the structure and resources available in under-resourced community mental health centers in distant communities.

References

1. Bruns EJ, Pullmann MD, Sather A, Brinson RD, Ramey M. Effectiveness of wraparound versus case management for children and adolescents: results of a randomized study. Administration and Policy in Mental Health Services Research. 2015;42:309-322.
2. Kriechman A, Bonham C. Telemental health in primary care. In: Telemental Health: Clinical, Technical, and Administrative Foundations for Evidence-based Practice. Eds: Myers K and Turvey C. Elsevier Insights. Waltham, 2013.
3. U.S. Department of Health and Human Services. Patient Protection and Affordable Care Act (ACA); Public Law 111-148; 2010. https://www.govinfo.gov/content/pkg/STATUTE-124/pdf/STATUTE-124-Pg119.pdf
4. Thomas K, Ellis A, Konrad T, Holzer C, Morrissey J: County-level estimates of mental health professional shortage in the united states. Psychiatric Services 60:1323-1328, 2009.
5. The Muskie School of Public Service. The Role of Community Mental Health Centers as Rural Safety Net Providers Working Paper #30 November 2002; https://muskie.usm.maine.edu/Publications/rural/wp30.pdf Accessed July 1, 2018.