Children and Telehealth in Mental Healthcare: What We Have Learned From COVID‐19 and 40,000+ Sessions

Abstract

Objective Of the many impacts of COVID‐19 on contemporary healthcare is the rapid and overwhelming shift to remote telehealth (TH) service. The precise effect of TH on treatment is yet unknown, and the possible child/adult differences are an essential point of clarification for the utility of TH services and efforts to improve upon them. Methods The current study considers data reflecting pre‐, during‐, and post‐COVID‐19 lockdown over the first six months of 2020. Data comprise records of N = 43,294 services delivered to N = 2520 unique clients across multiple outpatient mental health sites at a Certified Community Based Mental Health Clinic (CCBHC) in Rockland County, NY, an area hard hit by COVID‐19. Results Results demonstrate significant differences between child and adult sessions with a relative decrease in the number of child mental health services with the switch to TH in March 2020 (onset of lockdown) and a relatively rapid shift back to face‐to‐face among child services when in‐person services resumed in May and June 2020. Results further highlight significant differences between child age and service type, with psychiatry less affected by TH than psychotherapy. Conclusions Implicit in the data is the ability to offer remotely, a high volume of ongoing behavioral intervention. Findings support TH as less preferred for children than adults while indicating that child TH is favored for psychiatry and support services, less so for psychotherapy. Implications for enhancing child TH delivery and directions for continued research include relational factors, platform (phone/video) and screen salience.

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation

“…Such a pivot was not without its challenges, including limited access to technology and the internet, especially in low income and rural areas, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a HIPAA-compliant platform, training providers and clients in use, and reimbursement challenges. Preference for face-to-face services and difficulty using telehealth with young children was also reported in a study by Hoffnung and colleagues [ 31 ].…”

The Impact of the Covid-19-Related Transition to Telehealth on Visit Adherence in Mental Health Care: An Interrupted Time Series Study

“…The literature on TMH among pediatric populations has identified mixed support for TMH. One study reported that adults preferred TMH visits and children were twice as likely to return to face-to-face visits following the lock down, compared to adults (Hoffnung et al, 2021 ). Yet, another study found that young people aged 12–25 reported that TMH was effective and that it made them less likely to cancel visits.…”

“…This is critical in mental healthcare where stress related to the virus and mitigation efforts may heighten symptoms among those with mental health concerns (Asmundson et al, 2020;Druss, 2020;Zhou et al, 2020). To address these concerns, telemental health (TMH), which includes the synchronous delivery of mental health services through electronic technologies including video and telephone, has been widely adopted by healthcare organizations (Baum et al, 2021;Connolly et al, 2020;Hoffnung et al, 2021;Mishkind et al, 2020;Shore et al, 2020;Tse et al, 2020). TMH is an effective means for delivering mental health services to diverse populations presenting with a variety of conditions (Bashshur et al, 2016;Fiacco et al, 2021).…”

Addressing Pediatric Mental Health Using Telehealth During Coronavirus Disease-2019 and Beyond: A Narrative Review

“…10,11,44 However, less engagement in pediatric telehealth was noted specifically for psychotherapy compared to medication management. 45 Interestingly, in a community sample of high school youth, a sizable portion (one third) reported mental health concerns due to COVID-19, but only 40% intended to seek treatment. These findings mirror that of an intensive outpatient clinic providing mental health services, who reported increased rates of attendance via telehealth, 46 but an overall decline in service use.…”