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Döpfner M, von Wirth E, Adam J, Goldbeck C, Schulze-Husmann K, Herpertz-Dahlmann B, Simons M, Heuer F, Schwendowius J, Poustka L, Wegner C, Bender S. Feasibility, satisfaction, and goal attainment in routine telemedicine consultation in child and adolescent psychiatry and psychotherapy. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02477-9. [PMID: 38836920 DOI: 10.1007/s00787-024-02477-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 05/18/2024] [Indexed: 06/06/2024]
Abstract
Telehealth services were rapidly adopted during the COVID-19 pandemic, but evidence regarding the effectiveness and feasibility of telehealth services in child and adolescent mental healthcare is sparse. This study aims to investigate feasibility, satisfaction, and goal attainment in video-delivered consultations in routine care child and adolescent psychiatry and psychotherapy. A total of 1046 patients from four university child and adolescent outpatient psychiatric clinics and one university outpatient unit for child and adolescent psychotherapy were screened for study participation. We examined a) the percentage of patients considered eligible for video-delivered consultation, b) clinicians', parents' and patients' satisfaction with video consultation, c) clinicians' ratings of goal attainment in video consultation, and d) factors associated with satisfaction and goal attainment. 59% of the screening sample (n = 621) fulfilled eligibility criteria and were considered eligible for video consultation. A total of 267 patients consented to participate in the study and received a video consultation. Clinicians reported high levels of satisfaction with video consultation and high levels of goal attainment in video consultations, especially for patients scheduled for initial patient assessments. Parents and patients were also highly satisfied with the video consultations, especially if patients had less severe emotional and behavioral problems. The present findings suggest that video consultations are a feasible and well-accepted alternative to in-person consultations in child and adolescent mental health care, especially for children with less severe symptoms and for children in early phases of assessment and treatment. Limitations include the lack of a control group. The study was registered at the German Clinical Trials Registry (DRKS00023525).
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Affiliation(s)
- Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Elena von Wirth
- Department of Clinical Child and Adolescent Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carolina Goldbeck
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Karen Schulze-Husmann
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Michael Simons
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, Germany
| | - Fabiola Heuer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Schwendowius
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christiane Wegner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Centre Göttingen, Göttingen, Germany
| | - Stephan Bender
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Sowa NA, Gaffney K, Sanders A, Murrell C. School-Based Tele-Behavioral Health: A Scoping Review of the Literature. THE JOURNAL OF SCHOOL HEALTH 2024; 94:571-580. [PMID: 38263701 DOI: 10.1111/josh.13435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Telehealth utilization exploded during the COVID-19 pandemic, including within school-based health programs. School-based tele-behavioral health can help programs overcome barriers of access to care, but the current state and effectiveness of such programs are unknown. METHODS A scoping literature review was conducted. Studies were included if they described in-school behavioral health services delivered via telehealth for children ages 5 to 18. From the included studies, population, location, setting, intervention, telehealth modality, clinician type, and outcomes assessed were extracted. FINDINGS Eighteen studies met inclusion criteria. All described psychotherapy or medication management delivered by psychologists (n = 7) and/or psychiatrists (n = 11). Treatment included psychotherapy (N = 8), psychiatric consultation (N = 7), medication management (N = 4), crisis stabilization (N = 1), and caregiver education (N = 1). Eight studies provide qualitative or quantitative outcomes, with 4 examining clinical effectiveness. CONCLUSIONS Despite limited findings in the literature, school-based tele-behavioral health is feasible, effective, and acceptable for delivery of behavioral health care to children and adolescents.
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Affiliation(s)
- Nathaniel A Sowa
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katie Gaffney
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amanda Sanders
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Murrell
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Shalev L, Bistre M, Lubin G, Avirame K, Raskin S, Linkovski O, Eitan R, Rose AJ. Enabling Expedited Disposition of Emergencies Using Telepsychiatry in Israel: Protocol for a Hybrid Implementation Study. JMIR Res Protoc 2023; 12:e49405. [PMID: 37847548 PMCID: PMC10618883 DOI: 10.2196/49405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Telepsychiatry is the use of virtual communication, such as a video link, to deliver mental health assessment, treatment, and follow-up. Previous studies have shown telepsychiatry to be feasible, accurate compared with in-person practice, and satisfying for psychiatrists and patients. Telepsychiatry has also been associated with reduced waiting times for evaluation and, in some studies, lower admission rates. However, most previous studies focused on using telepsychiatry in community settings and not on involuntary admission. OBJECTIVE The aim of this study is to examine the effectiveness and implementation process of patient assessment for involuntary admissions in the psychiatric emergency department (ED) using a video link. METHODS This type 1 hybrid implementation study will examine telepsychiatry effectiveness and the implementation process, by comparing telepsychiatry (n=240) with historical controls who had a face-to-face evaluation (n=240) during the previous, usual care period in 5 psychiatric EDs in Israel. A temporary waiver of the standing policy requiring in-person evaluations only, for the purpose of research, was obtained from the Israeli Ministry of Health. During the telepsychiatry phase, clinical staff and patients will join a video call from the ED, while the attending physician will log in elsewhere. The Promoting Action on Research Implementation in Health Services (PARIHS) framework will guide the evaluation of the telepsychiatry implementation process in the ED. PARIHS has the following 3 constructs: (1) evidence: staff's opinions regarding the innovation's viability and practicality, their satisfaction levels with its use, and patients' perceptions of the change; (2) context: level of approval of new strategies in the ED, decision-making processes, and the manner in which clinical teams converse and work together; (3) facilitation: adequacy of the facilitation efforts using champions reports. Primary clinical outcomes include ED length of stay and violent incidents obtained from medical records. RESULTS This study received Helsinki approval from the Ethics Committee of Abarbanel Mental Health Center (174; March 13, 2023), Jerusalem Mental Health Center (22-21; November 6, 2022), Lev-Hasharon Mental Health Medical Center (LH12023; February 12, 2023), Tel-Aviv Medical Center (TLV-22-0656; January 3, 2023), and Sha'ar Menashe (1-4-23; April 18, 2023). Data collection began in July 2023 in 2 study sites and will begin soon at the others. CONCLUSIONS Telepsychiatry could have significant benefits for patients in the psychiatric ED. Examining telepsychiatry effectiveness in the ED, in addition to identifying the facilitators and barriers of implementing it in different emergency settings, will facilitate better policy decisions regarding its implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT05771545; https://clinicaltrials.gov/study/NCT05771545. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49405.
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Affiliation(s)
- Ligat Shalev
- School of Public Health, Hebrew University, Jerusalem, Israel
| | - Moises Bistre
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Gadi Lubin
- The Jerusalem Mental Health Center, Jerusalem, Israel
| | - Keren Avirame
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Sergey Raskin
- Department of Forensic Psychiatry, Ministry of Health, Jerusalem, Israel
| | - Omer Linkovski
- Department of Psychology, Bar Ilan University, Ramat Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel
| | - Renana Eitan
- Psychiatric Division, Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Adam J Rose
- School of Public Health, Hebrew University, Jerusalem, Israel
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Mekori-Domachevsky E, Matalon N, Mayer Y, Shiffman N, Lurie I, Gothelf D, Dekel I. Internalizing symptoms impede adolescents' ability to transition from in-person to online mental health services during the 2019 coronavirus disease pandemic. J Telemed Telecare 2023; 29:725-730. [PMID: 34328367 DOI: 10.1177/1357633x211021293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Online mental health services were previously found to be effective in many studies. However, this method was not generally used in Israel. By the end of 2019, the coronavirus disease 2019 pandemic erupted, forcing mental health services to transition to online meetings to maintain the standard of care. In this cross-sectional study, we investigated the attitudes of adolescent patients toward this involuntary new mode of care. METHODS Forty-four adolescents (mean age 14.62 ± 2.12 years, 54.5% females) and 40 of their primary caregivers completed a battery of questionnaires that included the telemedicine satisfaction questionnaire, session evaluation questionnaire, working alliance inventory, and pediatric symptom checklist. RESULTS Both adolescents and their caregivers reported a reasonable experience with the online medium and a feeling that the meetings were overall powerful, helpful, and comfortable as demonstrated by medium to high scores on the telemedicine satisfaction questionnaire and session evaluation questionnaire questionnaires. A therapeutic alliance was generally maintained according to working alliance inventory scores. However, working alliance inventory scores were negatively correlated with higher levels of internalizing symptoms and parental stress. DISCUSSION Our findings point to the possibility that anxious/depressed adolescents will have greater difficulties re-establishing therapeutic alliance when transitioned from in-person to online meetings. This may be due to the introduction of an "invisible" third party to the therapeutic setting-the computer. Psychologists and psychiatrists should be aware of these difficulties and respond adequately to maintain the standard of care.
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Affiliation(s)
- Ehud Mekori-Domachevsky
- Sackler School of Medicine, Tel Aviv University, Israel
- Child and Adolescent Psychiatry Division, Sheba Medical Center, Israel
| | - Noam Matalon
- Sackler School of Medicine, Tel Aviv University, Israel
- Child and Adolescent Psychiatry Division, Sheba Medical Center, Israel
| | - Yael Mayer
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, Canada
| | | | - Ido Lurie
- Sackler School of Medicine, Tel Aviv University, Israel
- Shalvata Mental Health Center, Israel
| | - Doron Gothelf
- Sackler School of Medicine, Tel Aviv University, Israel
- Child and Adolescent Psychiatry Division, Sheba Medical Center, Israel
| | - Idit Dekel
- Sackler School of Medicine, Tel Aviv University, Israel
- Child and Adolescent Psychiatry Division, Sheba Medical Center, Israel
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Fell LA, Albright CM, Kryszak EM, Butter E, Kuhlthau KA. Provider Perspectives on Telehealth Services for Children With Autism Spectrum Disorder During the Coronavirus Disease 2019 Pandemic. Acad Pediatr 2023; 23:1196-1203. [PMID: 36871611 PMCID: PMC9985515 DOI: 10.1016/j.acap.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/13/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE The purpose of the current study was to explore provider perspectives on the strengths and challenges of telehealth services (e.g., behavioral interventions, physical, speech, and occupational therapy, medication management) for children with autism spectrum disorder during coronavirus disease 2019 related shutdowns. METHODS From September 2020 to May 2021, we conducted qualitative interviews with 35 providers across multiple disciplines from 17 sites in the Autism Care Network. Qualitative data were analyzed using a framework approach and common themes were identified. RESULTS Providers across clinical disciplines identified strengths of the virtual model, such as its flexibility and the opportunity it provided to see children in their home environment. They also indicated that some interventions worked better virtually than others, and that there were several factors that impacted their success. Respondents were generally satisfied providing parent-mediated interventions but expressed mixed satisfaction in using telehealth for direct-to-patient care. CONCLUSIONS Results suggest that telehealth services for children with autism spectrum disorder could be a helpful tool in decreasing barriers and improving service delivery, especially when tailored to the individual needs of the patient. More research is needed on the factors contributing to its success in order to eventually inform clinical guidelines regarding the prioritization of children seen for in-person visits.
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Affiliation(s)
- Lucy A Fell
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston.
| | - Charles M Albright
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Elizabeth M Kryszak
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Eric Butter
- Nationwide Children...s Hospital (CM Albright, EM Kryszak, and E Butter), Columbus, OH; Department of Pediatrics and Psychology (CM Albright, EM Kryszak, and E Butter), The Ohio State University, Child Development Center, Nationwide Children's Hospital, Westerville
| | - Karen A Kuhlthau
- Department of Pediatrics (LA Fell, and KA Kuhlthau), Massachusetts General Hospital, Boston; Department of Pediatrics (KA Kuhlthau), Harvard Medical School, Boston, MA
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von Wirth E, Meininger L, Adam J, Woitecki K, Treier AK, Döpfner M. Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists. J Telemed Telecare 2023:1357633X231157103. [PMID: 36883237 PMCID: PMC9996161 DOI: 10.1177/1357633x231157103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing. METHODS Caregivers (parents) and psychotherapists of n = 228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1). RESULTS At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35). CONCLUSION The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).
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Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Meininger
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne-Katrin Treier
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics. Healthcare (Basel) 2023; 11:healthcare11050765. [PMID: 36900770 PMCID: PMC10000553 DOI: 10.3390/healthcare11050765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/25/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. METHODS a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). RESULTS The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. CONCLUSIONS The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.
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Baker AJL, Konigsberg M, Brown E, Adkins KL. Successes, challenges, and opportunities in providing evidence-based teletherapy to children who have experienced trauma as a response to Covid-19: A national survey of clinicians. CHILDREN AND YOUTH SERVICES REVIEW 2023; 146:106819. [PMID: 36714194 PMCID: PMC9872563 DOI: 10.1016/j.childyouth.2023.106819] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/28/2022] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
While teletherapy is not a new phenomenon, most clinicians have not been trained and do not routinely practice it. The current study was designed to ascertain challenges and opportunities presented by the widescale usage of teletherapy especially for traumatized children, which was necessitated by the COVID-19 pandemic. Two hundred and fifty clinicians across the United States providing teletherapy to traumatized children completed an online survey. Results revealed that many logistical aspects of treatment were perceived to be easier when implemented remotely. Some clinical aspects of care were also perceived to be easier, notably engagement with caregivers. Developing rapport, assessing emotions, and keeping children's attention, however, were perceived as more challenging. Child characteristics such as age, attention span, and screen fatigue were viewed as creating challenges. Most clinicians had not received training in relevant topics for teletherapy and were eager to receive such training. These results suggest many avenues for refining and fine-tuning remote mental health services especially for children.
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Affiliation(s)
- Amy J L Baker
- Vincent J. Fontana Center for Child Protection of the New York Foundling, 590 Avenue of the Americas, NY, NY 10011, United States
| | - Melinda Konigsberg
- Little Flower Children and Families Services of New York, 630 Flushing Avenue, Brooklyn, NY, United States
| | - Elissa Brown
- St. John's University, 8000 Utopia Parkway, Jamaica, NY 11349, United States
| | - Kevin Lee Adkins
- Vincent J. Fontana Center for Child Protection of the New York Foundling, 590 Avenue of the Americas, NY, NY 10011, United States
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Bachmann CJ, Plener PL, Mechels M, Lempp T. [Maintaining a comprehensive provision of inpatient child and adolescent mental health services in the years to come-a German perspective]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:39-46. [PMID: 36717530 PMCID: PMC9886204 DOI: 10.1007/s40211-023-00458-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND A considerable number of child and adolescent psychiatry inpatient units in Germany suffer from a significant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services. METHODS Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry. RESULTS The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires a long-term, nationwide approach and considerable efforts of all departments involved.
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Affiliation(s)
- Christian J Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhövelstr. 5, 89075, Ulm, Deutschland. .,Wiener Gesundheitsverbund, Wien, Österreich.
| | - Paul L Plener
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhövelstr. 5, 89075, Ulm, Deutschland.,Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Malte Mechels
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Agaplesion Diakoniekrankenhaus, Rotenburg/Wümme, Deutschland
| | - Thomas Lempp
- Klinik für Kinder- und Jugendpsychosomatik, Clementine Kinderhospital, Frankfurt am Main, Deutschland
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Kister K, Laskowski J, Dybała E, Makarewicz A. Are we ready for Telepsychiatry? Benefits and challenges of digital
psychotherapy. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Telemedicine is one of the most modern and fastest-growing branches of medicine. The most common form is video consultation. We distinguish between synchronous and asynchronous telepsychiatry. This study aims to show the benefits of using telepsychiatry services, the challenges it poses to users, and to evaluate its use against traditional therapy.
Materials and methods: A review of literature from 1956-2023 in EMBASE, OpenKnowledge and PubMed databases was conducted. Keywords used were: telepsychiatry, teletherapy, and digital psychiatry. Ninety-eight articles were included.
Discussion: Telepsychiatry is an opportunity for regions affected by medical staff shortages. It bypasses cultural barriers, the problem of traveling and reduces the cost of medical point-of-service. Telepsychiatry is an opportunity for patients who do not use psychiatrists due to discrimination in a conservative society. Groups that may find it challenging include the elderly, the blind, and the deaf. Creating a healthy therapeutic alliance through a screen can be impossible, making it difficult to achieve successful therapy. A barrier to developing telepsychiatry is the need for more guidelines for dealing with medical errors.
Conclusions: Telemedicine can help in accessing specialized care regardless of location. Telepsychiatry provides a safe and anonymous environment for patients reluctant to receive inpatient therapy. The effectiveness of online therapy is primarily debated. Telepsychiatry should be limited to follow-up consultations and well-known patients - it is a form of complementing the diagnosis and treatment process. The authors point to the need for developing specific guidelines for conducting teletherapy with particular attention to the problem of suicide.
Keywords: telepsychiatry, teletherapy, digital psychiatry.
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Affiliation(s)
- Klaudia Kister
- I Departmentof Psychiatry, Psychoterapy and Early Intervention of Medical University in Lublin, Poland - Students Research Group
| | - Jakub Laskowski
- Department of Paediatrician Oncology, Transplantology and Haematology Medical University of Lublin, Poland - Students Research Group
| | | | - Agata Makarewicz
- I Department of Psychiatry, Psychoterapy and Early Intervention, Medical University of Lublin, Poland
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Davis DW, Jawad K, Lohr WD, Trace M, Le J, Feygin Y, Jones VF. First-line Behavioral Health Treatment Prior to Stimulant or Alpha-2 Agonist Use for Preschoolers on Kentucky Medicaid in 2017. J Atten Disord 2023; 27:437-446. [PMID: 36635886 DOI: 10.1177/10870547221147543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE We aimed to assess the degree to which the American Academy of Pediatrics' (AAP) clinical guidelines were followed when treating attention deficit/hyperactivity disorder (ADHD) in preschoolers. METHOD Using Medicaid claims for children 4 to 5 years of age receiving their first dose of stimulants/alpha-2 agonists in 2017 (n = 836), we determined if BH was received prior to initiation of medication. We examined predictors after controlling for confounders. RESULTS More than half the sample did not receive first-line BH, which did not differ by demographics. Those receiving BH prior to medication had a higher rate of receiving an ADHD diagnosis. Only three diagnoses were significant in multivariate (OR 13.8, 95% CI [1.7-115.1]) analyses. CONCLUSION More than half the sample did not, conservatively, meet the AAP clinical recommendations. Further research is needed to identify targets for intervention. Limitations are noted.
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Affiliation(s)
- Deborah Winders Davis
- University of Louisville School of Medicine, KY, USA
- Norton Children's Research Institute affiliated with the University of Louisville School of Medicine, KY, USA
| | - Kahir Jawad
- Norton Children's Research Institute affiliated with the University of Louisville School of Medicine, KY, USA
| | - William David Lohr
- University of Louisville, KY, USA
- Norton Children's Medical Group, Louisville, KY, USA
- Kentucky Department of Community Based Services, Frankfort, USA
| | - Marie Trace
- Cleveland Clinic Children's Hospital, OH, USA
| | - Jennifer Le
- University of Louisville, KY, USA
- Norton Children's Medical Group, Louisville, KY, USA
| | - Yana Feygin
- Norton Children's Research Institute affiliated with the University of Louisville School of Medicine, KY, USA
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12
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Abstract
Telemental health-the use of videoconferencing or audio only (telephone) in mental health care-has accelerated tremendously since the start of the covid-19 pandemic. Meta-analyses have examined the reliability (ie, concordance) of assessment and the efficacy/effectiveness of telemental health compared with in-person care. Results indicate that telemental health assessment and clinical outcomes are similar compared with in-person care but there is much unexplained variability, as well as evidence that patient clinical and demographic characteristics can influence these findings. Further, gaps exist in the literature regarding specific patient populations (eg, psychotic disorders, children/adolescents), treatment modalities (eg, group therapy), audio only telemedicine, and hybrid care that mixes in-person with telemental health care. These gaps provide important directions for the next generation of telemental health research. Comprehensive clinical guidelines from mental health organizations are available to telemental health practitioners and focus on five content themes: legal and regulatory issues, clinical considerations, standard operating procedures and protocols, technical requirements, and considerations of specific populations and settings.
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Affiliation(s)
| | - Alisa B Busch
- McLean Hospital, Harvard Medical School, Belmont, MA
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13
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Gutiérrez-Rojas L, Alvarez-Mon MA, Andreu-Bernabeu Á, Capitán L, de Las Cuevas C, Gómez JC, Grande I, Hidalgo-Mazzei D, Mateos R, Moreno-Gea P, De Vicente-Muñoz T, Ferre F. Telepsychiatry: The future is already present. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:51-57. [PMID: 37689522 DOI: 10.1016/j.rpsm.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/02/2022] [Accepted: 09/02/2022] [Indexed: 09/11/2023]
Abstract
This review paper analyzes the state of knowledge on Telepsychiatry (TP) after the crisis caused by COVID and the resulting need to use new modalities of care. Six essential aspects of TP are addressed: patient's and mental health staff satisfaction, diagnostic reliability, effectiveness of TP interventions, cost-effectiveness in terms of opportunity cost (or efficiency), legal aspects inherent to confidentiality and privacy in particular and the attitude of professionals toward TP. Satisfaction with TP is acceptable among both patients and professionals, the latter being the most reluctant. Diagnostic reliability has been demonstrated, but requires further studies to confirm this reliability in different diagnoses and healthcare settings. The efficacy of TP treatments is not inferior to face-to-face care, as has been proven in specific psychotherapies. Finally, it should be noted that the attitude of the psychiatrist is the most decisive element that limits or facilitates the implementation of TP.
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Affiliation(s)
- Luis Gutiérrez-Rojas
- Department of Psychiatry and CTS-549 Research Group, Institute of Neurosciences, University of Granada, Granada, Spain; Department of Psychiatry, University of Granada, Granada, Spain.
| | - Miguel A Alvarez-Mon
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain
| | - Luis Capitán
- Psychiatry Service, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Carlos de Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Instituto Universitario de Neurociencia (IUNE) de la Universidad de La Laguna
| | | | - Iria Grande
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Diego Hidalgo-Mazzei
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Raimundo Mateos
- University of Santiago de Compostela, Department of Psyhciatry and CHUS University Hospital, Psychogeriatric Unit, Santiago de Compostela, Spain
| | | | | | - Francisco Ferre
- Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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14
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DeLaCruz-Jiron EJ, Hahn LM, Donahue AL, Shore JH. Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care. Curr Psychiatry Rep 2023; 25:1-6. [PMID: 36480149 PMCID: PMC9734763 DOI: 10.1007/s11920-022-01400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. RECENT FINDINGS Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides "OnDemand" treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.
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Affiliation(s)
| | - Lauren M. Hahn
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Amy L. Donahue
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Jay H. Shore
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA ,Department of Psychiatry and Family Medicine, School of Medicine and Centers for American Indian and Alaska Native Health Colorado School of Public Health, Anschutz Medical Campus, Aurora, USA
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15
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Erez G, Yakubovich S, Sadeh H, Shoval G, Schoen G, Meiri G, Hertz-Palmor N, Butler T, Barzilai Y, Mosheva M, Gothelf D, Bloch Y. Pediatric psychiatric emergency rooms during COVID-19: a multi-center study. BMC Psychiatry 2022; 22:828. [PMID: 36575441 PMCID: PMC9793352 DOI: 10.1186/s12888-022-04371-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/05/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.
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Affiliation(s)
- Galit Erez
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel
| | - Sol Yakubovich
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Hadar Sadeh
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Gal Shoval
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gila Schoen
- grid.415340.70000 0004 0403 0450Geha Mental Health Center and Tel Aviv University, Petah Tikva, Israel
| | - Gal Meiri
- grid.7489.20000 0004 1937 0511Soroka Medical Center and Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Nimrod Hertz-Palmor
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Tali Butler
- grid.415739.d0000 0004 0631 7092Ziv Medical Center (Safed) and Bar-Ilan University, Safed, Israel
| | - Yael Barzilai
- grid.415607.10000 0004 0631 0384Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Mariela Mosheva
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Doron Gothelf
- grid.413795.d0000 0001 2107 2845Sheba Medical Center and Tel Aviv University, Ramat Gan, Israel
| | - Yuval Bloch
- Shalvata Mental Health Center and Tel Aviv University, Hod Hasharon, Israel.
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16
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Huscsava MM, Scharinger C, Plener PL, Kothgassner OD. 'The world somehow stopped moving': impact of the COVID-19 pandemic on adolescent psychiatric outpatients and the implementation of teletherapy. Child Adolesc Ment Health 2022; 27:232-237. [PMID: 34114730 DOI: 10.1111/camh.12481] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. METHOD Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. RESULTS Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. CONCLUSIONS Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.
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Affiliation(s)
- Mercedes M Huscsava
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Scharinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Child- and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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17
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Kreski NT, Chen Q, Olfson M, Cerdá M, Hasin DS, Martins SS, Mauro PM, Keyes KM. Time use and associations with internalizing symptoms from 1991 to 2019 among US adolescents. SSM Popul Health 2022; 19:101181. [PMID: 35968043 PMCID: PMC9365953 DOI: 10.1016/j.ssmph.2022.101181] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Adolescent time use in recent cohorts is distinguished by large-scale changes, including shifts in parental monitoring, supervision, and adolescent activity patterns, that together may provide a more complete perspective on changing patterns of mental health than can be captured by single risk factors. Methods To determine whether patterns of adolescent time use explain recent increases in depressive and other internalizing symptoms, we first conducted latent profile analyses of 465,839 adolescents, grades 8/10, from annual, cross-sectional Monitoring the Future surveys, years:1991-2019, using twenty-one variables (e.g., frequency of attending parties) to identify groups based on patterns of time use. Most of the sample was female (51.0%), non-Hispanic white (58.8%), and in grade 8 (52.2%); mean age: 14.60 years (95% CI: 14.57, 14.64). We subsequently examined differences in depressive and other internalizing symptoms between these time use groups over time with survey-weighted logistic regressions producing odds ratios. Results Analyses derived six groups: part time workers, full time workers, and four groups based on levels of social activities (Low, medium, and high levels, with "High Social" split between those engaged in sports, academics, and community service and those who were not). Internalizing symptoms were predicted by lower socialization, low engagement in activities like sports, academics, and community service, and time spent at a paid job. Adolescents decreasingly engaged in social activities over time, though shifts in time use patterns did not account for much of the overall increase in depressive symptoms. Conclusion Shifts in adolescent time use do not explain increases in depressive and other internalizing symptoms, which increased across different patterns of time use. Levels of internalizing symptoms were highest among those with low socialization, low recreational engagement, and those working substantial hours. Encouraging socialization, engagement in recreational activities, and providing mental health resources for isolated adolescents may reduce internalizing symptom trends.
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Affiliation(s)
- Noah T Kreski
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th St, Room 733, New York, NY, 10032, USA
| | - Qixuan Chen
- Columbia University, Mailman School of Public Health, Department of Biostatistics, 722 West 168th Street, Room 644, New York, NY, 10032, USA
| | - Mark Olfson
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Department of Psychiatry, 1051 Riverside Dr, New York, NY, 10032, Box 24, USA
| | - Magdalena Cerdá
- New York University Grossman School of Medicine, Department of Population Health, 180 Madison Avenue 4-16, New York, NY, 10016, USA
| | - Deborah S Hasin
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Department of Psychiatry, 722 West 168th Street, Room 228F, New York, NY, 10032, USA
| | - Silvia S Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, 5th Floor, Room 509, New York, NY, 10032, United States
| | - Pia M Mauro
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, Room 507, New York, NY, 10032, USA
| | - Katherine M Keyes
- Columbia University, Mailman School of Public Health, Department of Epidemiology, 722 West 168th Street, Room 724, New York, NY, 10032, USA
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18
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Rosen V, Blank E, Lampert E, Dominick K, Will M, Erickson C, Pedapati E, Lamy M, Shaffer R. Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19. J Autism Dev Disord 2022; 52:5253-5265. [PMID: 35987932 PMCID: PMC9392497 DOI: 10.1007/s10803-022-05712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.
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19
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Rusu VA, van der Lans RM, Vermeiren RRJM, Hauber K, de Lijster JM, Lindauer RJL, Nugter A, Hoekstra PJ, Nooteboom LA. Training is not enough: child and adolescent psychiatry clinicians' impressions of telepsychiatry during the first COVID-19 related lockdown. Eur Child Adolesc Psychiatry 2022; 32:987-993. [PMID: 35986802 PMCID: PMC9391644 DOI: 10.1007/s00787-022-02042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
To ensure the continuity of care during the COVID-19 pandemic, clinicians in Child and Adolescent Psychiatry (CAP) were forced to immediately adapt in-person treatment into remote treatment. This study aimed to examine the effects of pre-COVID-19 training in- and use of telepsychiatry on CAP clinicians' impressions of telepsychiatry during the first two weeks of the Dutch COVID-19 related lockdown, providing a first insight into the preparations necessary for the implementation and provision of telepsychiatry during emergency situations. All clinicians employed by five specialized CAP centres across the Netherlands were invited to fill in a questionnaire that was specifically developed to study CAP clinicians' impressions of telepsychiatry during the COVID-19 pandemic. A total of 1065 clinicians gave informed consent and participated in the study. A significant association was found between pre-COVID-19 training and/or use of telepsychiatry and CAP clinicians' impressions of telepsychiatry. By far, the most favourable impressions were reported by participants that were both trained and made use of telepsychiatry before the pandemic. Participants with either training or use separately reported only slightly more favourable impressions than participants without any previous training or use. The expertise required to provide telepsychiatry is not one-and-the-same as the expertise that is honed through face-to-face consultation. The findings of this study strongly suggest that, separately, both training and (clinical) practice fail to sufficiently support CAP clinicians in the implementation and provision of telepsychiatry. It is therefore recommended that training and (clinical) practice are provided in conjunction.
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Affiliation(s)
- Vlad-Alexandru Rusu
- Curium LUMC, Oegstgeest, The Netherlands. .,Karakter, Wageningen, The Netherlands. .,de Bascule, Duivendrecht, The Netherlands. .,GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands. .,Accare, Assen, The Netherlands.
| | - R. M. van der Lans
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. R. J. M. Vermeiren
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - K. Hauber
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - J. M. de Lijster
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - R. J. L. Lindauer
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - A. Nugter
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - P. J. Hoekstra
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
| | - L. A. Nooteboom
- Curium LUMC, Oegstgeest, The Netherlands ,grid.461871.d0000 0004 0624 8031Karakter, Wageningen, The Netherlands ,grid.491096.3de Bascule, Duivendrecht, The Netherlands ,grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands ,grid.459337.f0000 0004 0447 2187Accare, Assen, The Netherlands
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20
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Meininger L, Adam J, von Wirth E, Viefhaus P, Woitecki K, Walter D, Döpfner M. Cognitive-behavioral teletherapy for children and adolescents with mental disorders and their families during the COVID-19 pandemic: a survey on acceptance and satisfaction. Child Adolesc Psychiatry Ment Health 2022; 16:61. [PMID: 35902959 PMCID: PMC9330974 DOI: 10.1186/s13034-022-00494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is challenging for health care systems around the world. Teletherapy (psychotherapy conducted via videoconference) for children and adolescents offers a promising opportunity not only to provide treatment during social distancing restrictions but also to reduce treatment barriers that might prevent families from seeking care independent of the pandemic. Therefore, it is highly important to examine the implementation and especially the acceptance of and satisfaction with teletherapy. METHODS Therapists of 561 patients and parents of 227 patients (total 643 patients) aged 3-20 years treated at a university outpatient unit rated their experiences with teletherapy. RESULTS Following the outbreak of COVID-19, 73% of the patients switched from face-to-face treatment to teletherapy. Both therapists and parents were mainly satisfied with teletherapy and did not report negative impacts on treatment satisfaction or the therapeutic relationship. Stress from COVID-19, age, gender, duration of treatment, psychosocial functioning, and psychopathology were associated with satisfaction, but correlations were low. Sixty-six percent of parents and 53% of therapists intended to use teletherapy in the future. CONCLUSIONS Teletherapy during the COVID-19 pandemic was well accepted by both parents and therapists. Certain patient characteristics were related to satisfaction. Trial registration The study was retrospectively registered in the German Clinical Trials Register (DRKS00028639).
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Affiliation(s)
- Lea Meininger
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Julia Adam
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Elena von Wirth
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Paula Viefhaus
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Katrin Woitecki
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Daniel Walter
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany
| | - Manfred Döpfner
- Faculty of Medicine and University Hospital Cologne, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University of Cologne, Pohligstr. 9, 50969, Cologne, Germany.
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany.
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21
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Ward MM, Ullrich F, Merchant KAS, Carter KD, Bhagianadh D, Lacks M, Taylor E, Gordon J. Describing Changes in Telebehavioral Health Utilization and Services Delivery in Rural School Settings in Pre- and Early Stages of the COVID-19 Public Health Emergency. THE JOURNAL OF SCHOOL HEALTH 2022; 92:452-460. [PMID: 35195293 DOI: 10.1111/josh.13150] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Receiving treatment for behavioral health disorders remains problematic due to profound provider shortages. Telebehavioral health services are effective for providing quality care, but research literature on these services in schools is limited. METHODS Data were collected during Fall 2019 and Spring 2020 semesters on all students receiving telebehavioral health services from 15 school-based telehealth programs across the U.S. RESULTS From Fall 2019 to Spring 2020, 62 schools providing services during both periods increased the number of students served from 396 to 745, increased the average number of encounters per student from 2.4 to 4.1, increased the percentage of encounters delivered by clinical social workers, mental health counselors, and clinical psychologists (all p < .001), and increased the use of individual counseling, family counseling, and group counseling (all p < .001). Schools that initiated the service in Spring 2020 (n = 25) averaged 6.5 encounters for the 301 students receiving services, delivered mostly by clinical social workers or professional counselors, using individual counseling. CONCLUSION Overall, data indicate programs significantly increased both behavioral services provided to their ongoing schools and increased the number of schools served. Undoubtedly telebehavioral health care delivery provided a swift and necessary response to the challenges posed by the growing pandemic threat.
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Affiliation(s)
- Marcia M Ward
- Department of Health Management and Policy, CPHB - N236, University of Iowa, Iowa City, IA, 52242, USA
| | - Fred Ullrich
- Department of Health Management and Policy, CPHB - N226, University of Iowa, Iowa City, IA, 52242, USA
| | - Kimberly A S Merchant
- Department of Health Management and Policy, CPHB - N242, University of Iowa, Iowa City, IA, 52242, USA
| | - Knute D Carter
- Department of Biostatistics, CPHB - N318, University of Iowa, Iowa City, IA, 52242, USA
| | - Divya Bhagianadh
- Department of Health Management and Policy, CPHB - N200, University of Iowa, Iowa City, IA, 52242, USA
| | - Meghan Lacks
- Brody School of Medicine, Department of Family Medicine, East Carolina University, 101 Heart Drive, Mail Stop 654, Greenville, NC, 27834, USA
| | - Erika Taylor
- Brody School of Medicine, Department of Family Medicine, East Carolina University, 101 Heart Drive. Mail Stop 654, Greenville, NC, 27834, USA
| | - Jennifer Gordon
- School Based Telehealth Initiative (SBTI), Bay Rivers Telehealth Alliance, 618 Hospital Road, Tappahannock, VA, 22560, USA
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22
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Davidson SK, Sanci L, de Nicolás Izquierdo C, Watson CJ, Baltag V, Sawyer SM. Best Practice During Teleconsultations With Adolescents: A Scoping Review. J Adolesc Health 2022; 70:714-728. [PMID: 35082052 DOI: 10.1016/j.jadohealth.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals. METHODS Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis. RESULTS Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders. DISCUSSION Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations.
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Affiliation(s)
- Sandra K Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Cathy J Watson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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23
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Colombo P, Busti Ceccarelli S, Pacchiarini S, Cribellati S, Molteni M. MedicalBIT: A web platform for Standardized Data Acquisition, Processing and Export in Child Psychopathology Clinical Routine. From design to implementation. (Preprint). JMIR Form Res 2022; 6:e36757. [PMID: 35816380 PMCID: PMC9315902 DOI: 10.2196/36757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The rapid extent of digital innovation for the collection of data has transformed the way in which health professionals collect, share, and analyze health information for better clinical decision-making and health care. In the last decade, there has been an increased interest in telemedicine by mental health agencies; the gap between the need for care and both diagnosis and treatment is wide, and digital technology could play an important role in filling this gap. However, there are limited data on the effectiveness of the clinical process and cost-effectiveness of most telemedicine applications. Objective This study examined the implementation of the first Italian online, web-based, comprehensive screening tool and described the screening and diagnostic process through the interactive web platform in a child psychopathology clinic. This is a feasibility study that aims to present the design and implementation of the best practices to improve patient experiences and clinical outcomes. Moreover, the paper evaluates the platform with qualitative and quantitative measures. Methods We planned, designed, and implemented a web-based system to collect, store, and manage clinical data. The platform was developed by a multidisciplinary team composed of researchers, clinicians, and informatics professionals through different steps. First, we defined the clinical information to be collected. A number of measures were chosen, tapping several clinical risk areas such as neurodevelopmental disorders and emotional and behavioral problems. The web application architecture and process were then designed. The three phases of process design are described in detail: design of the input interface, processing design, and design of the output interface. Finally, the system has been implemented and evaluated. Based on indicators recommended by the National Quality Forum and the Italian National Guidelines, we evaluated the quality of the system and used quantitative measures that were replicable and comparable over time. Results We present the implemented architecture and features of Medea Information and Clinical Assessment On-Line (MedicalBIT), and we provide performance measures for the data collected between October 2018 and June 2021. The measured concepts pertain to four domains: access to care, financial impact/cost, experience, and effectiveness. Conclusions In this study, we present the successful implementation of an innovative digital tool. The findings of this study show that the implemented web-based platform appears to be an efficient, cost-effective, and feasible way to improve digital care in the field of child psychiatry.
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Affiliation(s)
- Paola Colombo
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
| | - Silvia Busti Ceccarelli
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
| | | | | | - Massimo Molteni
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
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24
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The Transition of Academic Mental Health Clinics to Telehealth During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2022; 61:277-290.e2. [PMID: 34119633 PMCID: PMC8607958 DOI: 10.1016/j.jaac.2021.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 04/23/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE A consortium of 8 academic child and adolescent psychiatry programs in the United States and Canada examined their pivot from in-person, clinic-based services to home-based telehealth during the COVID-19 pandemic. The aims were to document the transition across diverse sites and to present recommendations for future telehealth service planning. METHOD Consortium sites completed a Qualtrics survey assessing site characteristics, telehealth practices, service use, and barriers to and facilitators of telehealth service delivery prior to (pre) and during the early stages of (post) the COVID-19 pandemic. The design is descriptive. RESULTS All sites pivoted from in-person services to home-based telehealth within 2 weeks. Some sites experienced delays in conducting new intakes, and most experienced delays establishing tele-group therapy. No-show rates and use of telephony versus videoconferencing varied by site. Changes in telehealth practices (eg, documentation requirements, safety protocols) and perceived barriers to telehealth service delivery (eg, regulatory limitations, inability to bill) occurred pre-/post-COVID-19. CONCLUSION A rapid pivot from in-person services to home-based telehealth occurred at 8 diverse academic programs in the context of a global health crisis. To promote ongoing use of home-based telehealth during future crises and usual care, academic programs should continue documenting the successes and barriers to telehealth practice to promote equitable and sustainable telehealth service delivery in the future.
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25
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Bock MM, Graf T, Woeber V, Kothgassner OD, Buerger A, Plener PL. Radical Acceptance of Reality: Putting DBT®-A Skill Groups Online During the COVID-19 Pandemic: A Qualitative Study. Front Psychiatry 2022; 13:617941. [PMID: 35546945 PMCID: PMC9082632 DOI: 10.3389/fpsyt.2022.617941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Emotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format. OBJECTIVE We aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed. METHODS A physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis. RESULTS Patients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective "gains" in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group. DISCUSSION Although the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to "basic" video-group-calls, such as "break-out sessions," blended therapy, or real-time supervision within an online session.
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Affiliation(s)
- Mercedes M Bock
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Psychosocial Services, Vienna, Austria
| | - Theres Graf
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Verena Woeber
- Department of Clinical Psychology and Psychotherapy, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria.,Department of Child and Adolescent Psychiatry, Wiener Gesundheitsverbund, University Clinic AKH, Vienna, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Arne Buerger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Würzburg, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Department of Child- and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
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26
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Jones LS, Russell A, Collis E, Brosnan M. To What Extent Can Digitally-Mediated Team Communication in Children's Physical Health and Mental Health Services Bring about Improved Outcomes? A Systematic Review. Child Psychiatry Hum Dev 2022; 53:1018-1035. [PMID: 33963964 PMCID: PMC8105145 DOI: 10.1007/s10578-021-01183-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 12/13/2022]
Abstract
Digital communication technologies can be used for team consultation, case management, and information sharing in health and mental health services for children and young people (CYP). The objective of the systematic review was to investigate the evidence as to whether digitally-mediated team communication for CYP improves outcomes. We searched PsycINFO, PubMed, Web of Science, and Cochrane Library for relevant studies. Results were synthesised narratively. Seven studies were identified from 439 initial records. Analysis highlighted that digitally-mediated team communication is generally valued by professionals for supporting practice and that there is overall satisfaction with the process. There was preliminary evidence (from one study) that clinical outcomes from digitally-mediated team communication are comparable to those achieved by a collaborative service model with direct specialist care to service users via digital communication technology. There is a need for further high-quality research into clinical outcomes and service user experience, as well as financial implications.
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Affiliation(s)
- Lauren Stephanie Jones
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Emma Collis
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY UK
| | - Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY UK
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27
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Keder RD, Mittal S, Stringer K, Wallis KE, Wallace JE, Soares NS. Society for Developmental & Behavioral Pediatrics Position Statement on Telehealth. J Dev Behav Pediatr 2022; 43:55-59. [PMID: 34855691 DOI: 10.1097/dbp.0000000000001046] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Telehealth has long held promise as a way to increase access to subspecialty care for children and families, including in developmental and behavioral pediatrics (DBP). The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid uptake of telehealth to continue care delivery that was facilitated by "temporary" policy changes related to the pandemic. As a result, the field of DBP has recognized telehealth as a potential model of care for performing home-based diagnostic assessments, providing medication management follow-up, and delivering therapeutic interventions for children with neurodevelopmental disorders. Telehealth has been helpful in mitigating barriers families often face when attending in-person visits (lack of transportation and child care, missed work hours, etc) but has also highlighted additional determinants of health that need to be addressed to provide equitable access to care (broadband connectivity, device access, digital literacy, access to interpretation and sign language services, etc). Anticipating the lifting of pandemic-related emergency declaration and expiration of temporary policies around telehealth, the ability to continue to deliver DBP care by telehealth is uncertain. The purpose of this policy statement is to advocate for legislation and policies that support ongoing, equitable, home-based telehealth care for patients seen by DBP providers while ensuring equitable access to DBP in general. In addition, there is a need to recognize the benefits and challenges of telehealth versus in-person care and to identify clinical scenarios that favor 1 model of care versus the other.
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Affiliation(s)
- Robert D Keder
- Department of Pediatrics, Developmental & Behavioral Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, CT
| | - Shruti Mittal
- Developmental and Behavioral Pediatrics of the Carolinas, Atrium Health, Concord, NC
| | - Kimberlly Stringer
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, University of Alabama Medicine, Birmingham, AL
| | - Kate E Wallis
- Division of Developmental and Behavioral Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jenna E Wallace
- Department of Behavioral Medicine and Psychiatry, Department of Pediatrics, Section of Neurology, West Virginia University School of Medicine, Morgantown, WV
| | - Neelkamal S Soares
- Division of Developmental-Behavioral Pediatrics, Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI
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28
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Martinez RG, van Dyk IS, Kroll JL, Emerson ND, Bursch B. Recommendations for building telemental health relationships with youth: A systematic review and resource for clinicians. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:349-362. [PMID: 36248612 PMCID: PMC9562612 DOI: 10.1080/23794925.2021.1970050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Ruben G. Martinez
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Ilana Seager van Dyk
- Department of Social & Behavioral Science, Yale School of Public Health, New Haven, CT
| | - Juliet L. Kroll
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TC
| | - Natacha D. Emerson
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA
| | - Brenda Bursch
- Department of Psychiatry & Biobehavioral Sciences, UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior, Los Angeles, CA,Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, CA
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Abstract
AIMS AND METHOD This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. RESULTS We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. CLINICAL IMPLICATIONS The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.
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30
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Sengupta S. Engaging Pediatric Primary Care Clinicians in Collaborative and Integrated Care. Child Adolesc Psychiatr Clin N Am 2021; 30:767-776. [PMID: 34538447 DOI: 10.1016/j.chc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric primary care clinicians (PPCCs) are managing increasing mental health challenges in the children and adolescents they treat. Child and adolescent psychiatrists (CAPs) are increasingly involved in collaborative and integrated care (CIC) work that builds the knowledge and skills of PPCCs to manage mild to moderate mental health challenges for children and adolescents in primary care. CAPs who can establish good working relationships, communicate clearly and efficiently, and facilitate the care of this population will be successful in engaging our PPCC partners in CIC.
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Affiliation(s)
- Sourav Sengupta
- Departments of Psychiatry & Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA; Children's Psychiatry Clinic of Oishei Children's Hospital, 1028 Main Street, Buffalo, NY 14202, USA.
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32
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Sharma A, Feuer V, Stuart BK, Folk JB, Doan BT, Kulkarni CA, Ramtekkar U, Fortuna L, Myers K. Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool. J Child Adolesc Psychopharmacol 2021; 31:464-474. [PMID: 34543079 DOI: 10.1089/cap.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Vera Feuer
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Krishna Stuart
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bridget T Doan
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Chetana A Kulkarni
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ujjwal Ramtekkar
- Department of Psychiatry and Behavioral Health, The Ohio State University School of Medicine, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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33
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Orsolini L, Pompili S, Salvi V, Volpe U. A Systematic Review on TeleMental Health in Youth Mental Health: Focus on Anxiety, Depression and Obsessive-Compulsive Disorder. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:793. [PMID: 34440999 PMCID: PMC8398756 DOI: 10.3390/medicina57080793] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 01/17/2023]
Abstract
Background and Objectives: The Internet is widely used and disseminated amongst youngsters and many web-based applications may serve to improve mental health care access, particularly in remote and distant sites or in settings where there is a shortage of mental health practitioners. However, in recent years, specific digital psychiatry interventions have been developed and implemented for special populations such as children and adolescents. Materials and Methods: Hereby, we describe the current state-of-the-art in the field of TMH application for young mental health, focusing on recent studies concerning anxiety, obsessive-compulsive disorder and affective disorders. Results: After screening and selection process, a total of 56 studies focusing on TMH applied to youth depression (n = 29), to only youth anxiety (n = 12) or mixed youth anxiety/depression (n = 7) and youth OCD (n = 8) were selected and retrieved. Conclusions: Telemental Health (TMH; i.e., the use of telecommunications and information technology to provide access to mental health assessment, diagnosis, intervention, consultation, supervision across distance) may offer an effective and efficacious tool to overcome many of the barriers encountering in the delivery of young mental health care.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Via Tronto 10/A, 60126 Ancona, Italy; (S.P.); (V.S.); (U.V.)
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34
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Mundt AP, Irarrázaval M, Martínez P, Fernández O, Martínez V, Rojas G. Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study. JMIR Public Health Surveill 2021; 7:e25836. [PMID: 34292164 PMCID: PMC8367295 DOI: 10.2196/25836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/24/2021] [Accepted: 04/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. Objective The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. Methods We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. Results During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. Conclusions The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.
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Affiliation(s)
- Adrian P Mundt
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - Matías Irarrázaval
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Departamento de Salud Mental, Ministerio de Salud, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Pablo Martínez
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
| | - Olga Fernández
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Unidad de Psiquiatria Infantil y del Adolescente, Departamento Psiquiatría y Salud Mental, Universidad de Chile, Santiago, Chile
| | - Vania Martínez
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Centro de Salud Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Universidad de Chile, Santiago, Chile
| | - Graciela Rojas
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile.,Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile.,Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile
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Liu J, Liu S, Zheng T, Bi Y. Physicians' Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study. JMIR Med Inform 2021; 9:e26463. [PMID: 33945493 PMCID: PMC8171288 DOI: 10.2196/26463] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/08/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non-COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. OBJECTIVE The purpose of this study was to understand physicians' attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. METHODS We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. RESULTS Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents' hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. CONCLUSIONS Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome.
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Affiliation(s)
- Jialin Liu
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu, China
| | - Siru Liu
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Tao Zheng
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yongdong Bi
- Department of Medical Informatics, West China Hospital, Sichuan University, Chengdu, China
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Novins DK, Stoddard J, Althoff RR, Charach A, Cortese S, Cullen KR, Frazier JA, Glatt SJ, Henderson SW, Herringa RJ, Hulvershorn L, Kieling C, McBride AB, McCauley E, Middeldorp CM, Reiersen AM, Rockhill CM, Sagot AJ, Scahill L, Simonoff E, Stewart SE, Szigethy E, Taylor JH, White T, Zima BT. Editors' Note and Special Communication: Research Priorities in Child and Adolescent Mental Health Emerging From the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2021; 60:544-554.e8. [PMID: 33741474 PMCID: PMC9188438 DOI: 10.1016/j.jaac.2021.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 01/07/2023]
Abstract
Over the last year, the coronavirus disease 2019 (COVID-19) pandemic has resulted in profound disruptions across the globe, with school closures, social isolation, job loss, illness, and death affecting the lives of children and families in myriad ways. In an Editors' Note in our June 2020 issue,1 our senior editorial team described this Journal's role in advancing knowledge in child and adolescent mental health during the pandemic and outlined areas we identified as important for science and practice in our field. Since then, the Journal has published articles on the impacts of the pandemic on child and adolescent mental health and service systems,2-5 which are available in a special collection accessible through the Journal's website.6 Alongside many opinion papers, the pace of publication of empirical research in this area is rapidly expanding, covering important issues such as increased frequency of mental health symptoms among children and adolescents3,5,7-10 and changes in patterns of clinical service use such as emergency department visits.11-14 As the Senior Editors prepared that Editors' Note, they were acutely aware that the priorities that they identified were broad and generated by only a small group of scientists and clinicians. Although this had the advantage of enabling us to get this information out to readers quickly, we decided that a more systematic approach to developing recommendations for research priorities would be of greater long-term value. We were particularly influenced by the efforts of the partnership between the UK Academy of Medical Scientists and a UK mental health research charity (MQ: Transforming Mental Health) to detail COVID-19-related research priorities for "Mental Health Science" that was published online by Holmes et al. in The Lancet Psychiatry in April 2020.15 Consistent with its focus on mental health research across the lifespan, several recommendations highlighted child development and children's mental health. However, a more detailed assessment of research priorities related to child and adolescent mental health was beyond the scope of that paper. Furthermore, the publication of that position paper preceded the death of George Floyd at the hands of Minneapolis police on May 25, 2020, which re-energized efforts to acknowledge and to address racism and healthcare disparities in the United States and many other countries. To build upon the JAACAP Editors' Note1 and the work of Holmes et al.,15 we conducted an international survey of professionals-practitioners and researchers-working on child and adolescent development and pediatric mental health to identify concerns about the impact of the pandemic on children, adolescents, and their families, as well as what is helping families navigate these impacts, and the specific research topics that are of greatest importance.
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Affiliation(s)
- Douglas K. Novins
- Dr. Novins, Editor-in-Chief, and Dr. Stoddard, Editorial Board member, are with the University of Colorado Anschutz Medical Campus, Aurora,Correspondence to Douglas K. Novins, MD, University of Colorado Anschutz Medical Campus, Departments of Psychiatry and Community and Behavioral Health, Children's Hospital Colorado, 13123 East 16th Avenue, B13013055 East 17th Avenue, Aurora, CO 80045
| | - Joel Stoddard
- Dr. Novins, Editor-in-Chief, and Dr. Stoddard, Editorial Board member, are with the University of Colorado Anschutz Medical Campus, Aurora
| | - Robert R. Althoff
- Dr. Althoff, Associate Editor, is with the University of Vermont, Burlington
| | - Alice Charach
- Dr. Charach, Editorial Board member, is with The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samuele Cortese
- Dr. Cortese, Deputy Editor, is with the Center for Innovation in Mental Health, Academic Unit of Psychology, Faculty of Environmental and Life Sciences; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; New York University Child Study Center, New York; and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, United Kingdom
| | - Kathryn Regan Cullen
- Dr. Cullen, Editorial Board member, is with the University of Minnesota, Minneapolis
| | - Jean A. Frazier
- Dr. Frazier, Deputy Editor, is with University of Massachusetts Medical School, Worcester
| | - Stephen J. Glatt
- Dr. Glatt, Editor-At-Large for Methodology and Statistics, is with SUNY Upstate Medical University, Syracuse, New York
| | - Schuyler W. Henderson
- Dr. Henderson, Deputy Editor, is with New York University Langone School of Medicine, New York, and Bellevue Hospital, New York
| | - Ryan J. Herringa
- Dr. Herringa, Editorial Board member, is with the University of Wisconsin Madison School of Medicine and Public Health, Madison
| | - Leslie Hulvershorn
- Dr. Hulvershorn, Editorial Board member, is with Indiana University School of Medicine, Indianapolis
| | - Christian Kieling
- Dr. Kieling, International Editor-at-Large, is with Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Anne B. McBride
- Dr. McBride, John F. McDermott, MD, Assistant Editor-In-Residence, is with University of California, Davis
| | - Elizabeth McCauley
- Dr. McCauley, Deputy Editor, is with Seattle Children's Hospital, Washington
| | - Christel M. Middeldorp
- Dr. Middeldorp, International Editor-at-Large, is with the University of Queensland, Brisbane, Australia
| | - Angela M. Reiersen
- Dr. Reiersen, Editor-At-Large for Methodology and Statistics, is with Washington University School of Medicine, St. Louis, Missouri
| | - Carol M. Rockhill
- Dr. Rockhill, Editorial Board member, is with Seattle Children's Hospital, Washington
| | - Adam J. Sagot
- Dr. Sagot, JAACAP Connect Editorial Board member, is with the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Lawrence Scahill
- Dr. Scahill, Consulting Editor, is with Emory University, Atlanta, Georgia
| | - Emily Simonoff
- Dr. Simonoff, Editorial Board member, is with King's College London, United Kingdom
| | - S. Evelyn Stewart
- Dr. Stewart, Editorial Board member, is with the University of British Columbia, Vancouver
| | - Eva Szigethy
- Dr. Szigethy, Editorial Board member, is with the University of Pittsburgh Medical Center, Pennsylvania
| | - Jerome H. Taylor
- Dr. Taylor, former Contributing Editor, is with Children's Hospital of Philadelphia, Pennsylvania
| | - Tonya White
- Dr. White, Deputy Editor, is with Erasmus University Medical Centre – Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bonnie T. Zima
- Dr. Zima, Consulting Editor, is with University of California, Los Angeles
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Boldt K, Coenen M, Movsisyan A, Voss S, Rehfuess E, Kunzler AM, Lieb K, Jung-Sievers C. Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on Children-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2361. [PMID: 33670974 PMCID: PMC7967755 DOI: 10.3390/ijerph18052361] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 01/01/2023]
Abstract
The aim of this study was to identify interventions targeting children and their caregivers to reduce psychosocial problems in the course of the COVID-19 pandemic and comparable outbreaks. The review was performed using systematic literature searches in MEDLINE, Embase, PsycINFO and COVID-19-specific databases, including the CDC COVID-19 Research Database, the World Health Organisation (WHO) Global Database on COVID-19 Research and the Cochrane COVID-19 Study Register, ClinicalTrials.gov, the EU Clinical Trials Register and the German Clinical Trials Register (DRKS) up to 25th September 2020. The search yielded 6657 unique citations. After title/abstract and full text screening, 11 study protocols reporting on trials planned in China, the US, Canada, the UK, and Hungary during the COVID-19 pandemic were included. Four interventions targeted children ≥10 years directly, seven system-based interventions targeted the parents and caregivers of younger children and adolescents. Outcome measures encompassed mainly anxiety and depressive symptoms, different dimensions of stress or psychosocial well-being, and quality of supportive relationships. In conclusion, this systematic review revealed a paucity of studies on psychosocial interventions for children during the COVID-19 pandemic. Further research should be encouraged in light of the expected demand for child mental health management.
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Affiliation(s)
- Katharina Boldt
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Stephan Voss
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
| | - Angela M. Kunzler
- Department of Psychiatry and Psychotherapy, University Medical Center, 55131 Mainz, Germany; (A.M.K.); (K.L.)
- Leibniz Institute for Resilience Research (LIR), 55122 Mainz, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center, 55131 Mainz, Germany; (A.M.K.); (K.L.)
- Leibniz Institute for Resilience Research (LIR), 55122 Mainz, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology—IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (K.B.); (M.C.); (A.M.); (S.V.); (E.R.)
- Pettenkofer School of Public Health, 81377 Munich, Germany
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Georgiopoulos AM, Christon LM, Filigno SS, Mueller A, Prieur MG, Boat TF, Smith BA. Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention. Pediatr Pulmonol 2021; 56 Suppl 1:S107-S122. [PMID: 32706527 DOI: 10.1002/ppul.24977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.
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Affiliation(s)
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Mueller
- Departments of Pulmonology and Social Work Services, Hartford Hospital, Hartford, Connecticut
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Beth A Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo--The State University of New York, Buffalo, New York
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A Survey Comparing Adult and Child Psychiatry Trainees, Faculty, and Program Directors' Perspectives About Telepsychiatry: Implications for Clinical Care and Training. ACTA ACUST UNITED AC 2021; 6:338-347. [PMID: 33501373 PMCID: PMC7820828 DOI: 10.1007/s41347-020-00187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022]
Abstract
Telepsychiatry’s effectiveness is well established, and interest in it is growing, despite few residency/fellowship core curricula and rotations. A link to a cross-sectional survey was sent via national organization listservs for psychiatry residents, fellows, faculty, and program directors to complete. The survey queried demographics, clinical experience, and views/concerns about telepsychiatry. Descriptive statistics and other analyses compared groups to assess the impact of amount clinical experience and psychiatric specialty (general vs. child and adolescent psychiatry), on interest, and views/concerns about the practice of telepsychiatry. All respondents (N = 270; child psychiatry N = 89) have limited clinical experience with telepsychiatry (46% overall; 49% of non-child had none versus 40% child). Trainees (N = 123; child N = 43) expressed less interest than others. All respondents expressed worry about ability to do a physical exam, connectivity, medico-legal issues, and fit for diverse populations. Child respondents expressed less concern than others, but they reported more worry about loss of nonverbal cues. Clinical experience with telepsychiatry in the range of 6–20 h appears to build interest and allay concerns, though 1–5 h also may have a positive impact. More research is needed to assess clinical experience, interest, and concerns for adult and child psychiatry trainees and clinicians. Replicable, curricular interventions appear to be indicated.
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40
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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Khairetdinov O, Bebchuk M, Vladzymyrskyy A, Morozov S. State and prospects of legal regulation of telemedicine consultation in the patient-specialist format in children’s psychiatric practice. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:103-107. [DOI: 10.17116/jnevro2021121112103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sezgin E, Huang Y, Lin D, Ramtekkar U, Pauline L, Lin S. Documented Reasons of Cancellation and Rescheduling of Telehealth Appointments During the Pandemic. Telemed J E Health 2020; 27:1143-1150. [PMID: 33373553 DOI: 10.1089/tmj.2020.0454] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objective: The COVID-19 pandemic increased the use of telehealth around the world. The aim is to minimize health care service disruption as well as reducing COVID-19 exposure. However, one of the major operational concerns is cancellations and rescheduling (C/Rs). C/Rs may create additional burden and cost to the patient, provider, and the health system. Our aim is to understand the reasons for C/Rs of the telehealth session after the scheduled start time. Materials and Methods: We reviewed electronic health records (EHRs) to identify the C/R reasons for behavioral health and speech language pathology departments. Documented C/Rs in the medical charts were identified from EHR by using a keyword-based and Natural Language Processing (NLP)-supported EHR search engine. From the search results, we randomly selected 200 notes and conducted a thematic analysis. Results: We identified four themes explaining C/R reasons. Most frequent theme was "technicality" (47, 36%), followed by "engagement" (34, 25%), "scheduling" (31, 24%), and "unspecified" (20, 15%). The findings showed that technical reasons are the leading cause of C/Rs, constituting 36% of the cases (95% confidence interval [CI]: 29-43%). Notably, "engagement" constituted a sizeable 25% (95% CI: 19-31%) of C/Rs, as a result of the inability to engage a patient to complete the telehealth session. Conclusions: The study shows that engagement is one of the new challenges to the pediatric telehealth visits. Future studies of new engagement models are needed for the success of telehealth. Our findings will help fill the literature gaps and may help with enhancing the digital experience for both caregivers and providers, reducing wasted time and resources due to preventable C/Rs, improving clinical operation efficiency, and treatment adherence.
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Affiliation(s)
- Emre Sezgin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Yungui Huang
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Deborah Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ujjwal Ramtekkar
- Department of Psychiatry, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Psychiatry, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Lindsey Pauline
- Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Simon Lin
- Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
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Rousseau C, Miconi D. Protecting Youth Mental Health During the COVID-19 Pandemic: A Challenging Engagement and Learning Process. J Am Acad Child Adolesc Psychiatry 2020; 59:1203-1207. [PMID: 33126993 DOI: 10.1016/j.jaac.2020.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/10/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022]
Abstract
Globally, the COVID-19 pandemic is causing extensive morbidity and mortality and is fueling psychological distress across populations. Early evidence has shown an increase in anxiety, depression and sleep problems in the general population.1,2 Although pandemics shatter the functioning of communities and families globally, there is a paucity of studies targeting the effects of pandemics on youth mental health.
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Affiliation(s)
- Cécile Rousseau
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada.
| | - Diana Miconi
- Faculty of Medicine, McGill University, Montréal, Quebec, Canada
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Doan BT, Yang YB, Romanchych E, Grewal S, Monga S, Pignatiello T, Bryden P, Kulkarni C. From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020; 51:1-7. [PMID: 33110276 PMCID: PMC7582436 DOI: 10.1007/s10879-020-09478-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/30/2022]
Abstract
COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients’ homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services.
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Affiliation(s)
- Bridget T Doan
- Hospital for Sick Children (SickKids), Toronto, ON Canada
| | - Yue Bo Yang
- MD Undergraduate Program, University of British Columbia, Vancouver, BC Canada
| | | | - Seena Grewal
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Suneeta Monga
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Tony Pignatiello
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Pier Bryden
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
| | - Chetana Kulkarni
- Hospital for Sick Children (SickKids), Toronto, ON Canada.,University of Toronto, Toronto, ON Canada
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Kommu JVS, Sharma E, Ramtekkar U. Telepsychiatry for Mental Health Service Delivery to Children and Adolescents. Indian J Psychol Med 2020; 42:46S-52S. [PMID: 33354063 PMCID: PMC7736747 DOI: 10.1177/0253717620959256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Children constitute 40% of India's population. Large number of children with psychiatric disorders and neurodevelopmental conditions are unable to access mental health services due to factors such as unavailability of these services in smaller urban and rural centres and lack of training for primary care providers. Given the relatively easy access to video conferencing technology, feasibility and acceptability of Telepsychiatry, there is an urgent need to invest resources and strengthen the use of Telepsychiatry for child and adolescent mental health training and serviced delivery . This viewpoint article discusses the need,scope,experiences and challenges related to use of Telepsychiatry in the area of child mental health.
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Affiliation(s)
| | - Eesha Sharma
- Dept. of Child and Adolescent Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | - Ujjwal Ramtekkar
- Dept. of Child and Adolescent Psychiatry, Nationwide Children's Hospital, Columbus, Ohio, USA
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46
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Palacio-Ortiz JD, Londoño-Herrera JP, Nanclares-Márquez A, Robledo-Rengifo P, Quintero-Cadavid CP. Psychiatric disorders in children and adolescents during the COVID-19 pandemic. REVISTA COLOMBIANA DE PSIQUIATRÍA (ENGLISH ED.) 2020. [PMCID: PMC7698655 DOI: 10.1016/j.rcpeng.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction The Covid-19 pandemic has generated an unprecedented multimodal (health, occupational, economic, and social) crisis, which will impact developing countries. Confinement as a preventive measure is itself a threat that produces a social impact. Pandemic and confinement have become a psychosocial adversity factor that affects families and their children. During the pandemic, children and adolescents with a psychiatric disorder may experience exacerbation of their symptoms. However, little is known about this, since studies on this population during the pandemic are scarce. Objective To review the data available in the current literature on the effect of the pandemic on children and adolescents with a previous psychiatric disorder. Methods A literature search was carried out using PubMed, Scielo and, due to the exceptional conditions of the pandemic situation, directly using internet search engines. Both English and Spanish papers were included. Results The information found is presented in the following sections: family and children during the pandemic, evaluation of mental disorders in children and young people during the pandemic, pre-existing psychiatric disorders during the pandemic, and telepsychiatric care. Specific information is presented on attention deficit hyperactivity disorder, autism spectrum disorder, intellectual disability, anxiety disorder, obsessive compulsive disorder, and post-traumatic stress disorder. The current pandemic due to COVID-19 and confinement are a psychosocial adversity that threatens the stability of the family. Such a stressor can cause exacerbation of symptoms of a previous mental disorder. Children and adolescents with psychiatric disorders are a vulnerable population and require specialised care. Telepsychiatry is becoming a modality with multiple advantages.
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Child and adolescent psychiatry telemedicine: A singaporean experience born in Covid-19. Asian J Psychiatr 2020; 53:102336. [PMID: 32854070 PMCID: PMC7426700 DOI: 10.1016/j.ajp.2020.102336] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
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Ramtekkar U, Bridge JA, Thomas G, Butter E, Reese J, Logan E, Lin S, Axelson D. Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19. JMIR Ment Health 2020; 7:e20157. [PMID: 32525485 PMCID: PMC7505681 DOI: 10.2196/20157] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 01/26/2023] Open
Abstract
The use of telebehavioral health has been expanding in the past decade to improve access to psychiatric care and address critical shortages in the psychiatric workforce. The coronavirus (COVID-19) pandemic forced a sudden shift from traditional in-person visits to alternative modalities. There are key factors associated with successful transitional and large-scale implementation of telehealth with existing resources. We describe the experience of a large health care system using telehealth technology, and we identify strategies and discuss considerations for long-term sustainability after the pandemic.
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Affiliation(s)
- Ujjwal Ramtekkar
- Department of Psychiatry, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jeffrey A Bridge
- Center for Suicide Prevention and Research, Departments of Pediatrics, Psychiatry & Behavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Glenn Thomas
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Eric Butter
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Jennifer Reese
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Erica Logan
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Simon Lin
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - David Axelson
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
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Sharma A, Sasser T, Schoenfelder Gonzalez E, Vander Stoep A, Myers K. Implementation of Home-Based Telemental Health in a Large Child Psychiatry Department During the COVID-19 Crisis. J Child Adolesc Psychopharmacol 2020; 30:404-413. [PMID: 32639849 DOI: 10.1089/cap.2020.0062] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: Telemental health (TMH) is not well described for mental health service delivery during crises. Most child and adolescent psychiatry training programs have not integrated TMH into their curricula and are ill equipped to respond during crises to their patients' needs. In this study, we present the implementation of a home-based TMH (HB-TMH) service during the COVID-19 pandemic. Methods: We describe the technological, administrative, training, and clinical implementation components involved in transitioning a comprehensive outpatient child and adolescent psychiatry program to a HB-TMH virtual clinic. Results: The transition was accomplished in 6 weeks. Most in-clinic services were rapidly moved off campus to the home. Owing to challenges encountered with each implementation component, phone sessions bridged the transition from in-clinic to reliable virtual appointments. Within 3 weeks (March 20, 2020) of planning for HB-TMH, 67% of all appointments were conducted at home, and within 4 weeks (March 27, 2020), 90% were conducted at home. By week 6 (April 3, 2020), reliable HB-TMH appointments were implemented. Conclusions: The COVID-19 pandemic crisis created the opportunity to innovate a solution to disrupted care for our established patients and to create a resource for youth who developed problems during the crisis. Our department was experienced in providing TMH services that facilitated the transition to HB-TMH, yet still had to overcome known and unanticipated challenges. Our experience provides a roadmap for establishing a HB-TMH service with focus on rapid implementation. It also demonstrates a role for TMH during (rather than after) future crises when usual community resources are not available.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Tyler Sasser
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin Schoenfelder Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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50
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Tan J, Fulford B. Debate: COVID crisis, natural capital and clinical care - 'building back better' for a new values-based CAMHS. Child Adolesc Ment Health 2020; 25:184-186. [PMID: 32734672 DOI: 10.1111/camh.12410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
The COVID-19 pandemic has meant upheaval for child and adolescent mental health services and for children, young people and their families. We look at this disruption through the lens of values-based practice. We also briefly examine the concept of natural capital and the opportunity for 'Building Back Better' post-COVID. We suggest that as well as losses, there are also opportunities to rethink and reshape our practices to make them more value-based.
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Affiliation(s)
- Jacinta Tan
- Aneurin Bevan University Health Board, Ty Bryn Unit, St Cadoc's Hospital, Newport, UK
| | - Bill Fulford
- The Collaborating Centre for Values-based Practice, St Catherine's College, University of Oxford, Oxford, UK
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