A systematic review of child and adolescent telepsychiatry was conducted. It was based on a search of the electronic databases MEDLINE and PsycINFO covering the period 1966 to June 2003. Studies were selected for review if they concerned videoconferencing for patient care or consultation, evaluated a clinical service or education, or assessed satisfaction with videoconferences. Twenty-seven articles were identified that fulfilled the selection criteria. These comprised two reports of randomized controlled experiments, 10 of descriptive questionnaire studies or observational surveys, seven case studies and eight other reports. Only three of the studies presented some calculations of cost-effectiveness. When classified by 'Quality of Evidence' criteria, only two studies were in category I (the highest), one was in II-2 and the rest fell into category III (the lowest). Most studies of child and adolescent telepsychiatry examined satisfaction with videoconferencing or described programmes or care regimens. Videoconferencing seemed to improve the accessibility of services and served an educational function. Some papers also mentioned savings in time, costs and travel. Problems with non-verbal communication and the audiovisual quality of the videoconference were mentioned as drawbacks. Telepsychiatry therefore seems to offer several benefits, at least in sparsely populated regions. Well designed and properly controlled trials are required to evaluate the clinical value of this promising method in child psychiatry, where there is a constantly increasing need for services.

To assess the current role of videoconferencing and the purposes for which it has been used in child and adolescent psychiatry in Finland, we sent a 16-item questionnaire to all providers of child and adolescent psychiatry services in specialised health care in Finland, i.e. the 42 child and adolescent units in 21 hospital districts. All service providers responded. The responses to both open-ended and structured questions were analysed manually and classified quantitatively and qualitatively. Use of videoconferencing was reported by 16 of the 21 hospital districts in Finland. Videoconferencing had been used for more than 5.5 years in only three hospital districts, for 3-5 years in 14 units and for 1-3 years in six units. Videoconferencing was used for clinical work in 12 and for distance education in another 12 hospital districts. Videoconferencing was used weekly for clinical work and for supervision by two districts; it was used for education by three districts. Although the workers' experiences of and attitudes towards videoconferencing were favourable, it has not been widely used in child and adolescent psychiatry. The implementation of videoconferencing seems to depend more on the activity of service providers than on the number of people involved.