Feasibility, Acceptability, and Sustainability of Telepsychiatry for Children and Adolescents

Myers, Kathleen; Valentine, J. Manson; Melzer, S. M.

doi:10.1176/appi.ps.58.11.1493

Cited by 94 publications

(39 citation statements)

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“…Receiving treatment in the home through telemethods may also increase treatment acceptability by overcoming matters of stigma and negative attitudes about attending a mental health clinic. Methods drawing on technological innovations for delivering expert mental health treatment are already being incorporated into routine care in large nonmetropolitan regions and show high parent satisfaction and preliminary evidence of efficacy, tolerability, and sustainability (Myers, Valentine, & Melzer, 2007, 2008; Nelson, Barnard, & Cain, 2003; Savin, Garry, Zuccaro, & Novins, 2006). For example, a centralized group of expert child psychiatrists and psychologists at Seattle Children’s Hospital (SCH) provide a high volume of children’s telepsychiatry services to seven partner sites across diverse and remote regions in the Pacific Northwest.…”

Section: Technological Innovations Overcome Many Traditional Barriersmentioning

confidence: 99%

Rationale and Considerations for the Internet-Based Delivery of Parent–Child Interaction Therapy

Comer

Furr

Cooper‐Vince

et al. 2015

Cognitive and Behavioral Practice

113

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Given the enormous individual, familial, and societal costs associated with early disruptive behavior disorders, transformative efforts are needed to develop innovative options for overcoming traditional barriers to effective care and for broadening the availability of supported interventions. This paper presents the rationale and key considerations for a promising innovation in the treatment of early-onset disruptive behavior disorders—that is, the development of an Internet-based format for the delivery of Parent-Child Interaction Therapy (PCIT) directly to families in their own homes. Specifically, we consider traditional barriers to effective care, and discuss how technological innovations can overcome problems of treatment availability, accessibility, and acceptability. We then detail our current Internet-delivered PCIT treatment program (I-PCIT), which is currently being evaluated across multiple randomized clinical trials relative to waitlist comparison, and to traditional in-office PCIT. Embedded video clips of children treated with I-PCIT are used to illustrate novel aspects of the treatment.

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Section: Technological Innovations Overcome Many Traditional Barriersmentioning

confidence: 99%

Rationale and Considerations for the Internet-Based Delivery of Parent–Child Interaction Therapy

Comer

Furr

Cooper‐Vince

et al. 2015

Cognitive and Behavioral Practice

113

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“…Several studies have shown that synchronous TMH that delivers services directly to children is feasible and acceptable to primary care providers (PCPs), 8–9 parents, 10 and youth, 11 and that TMH can be used reliably to establish diagnoses. 12–13 A few preliminary studies have suggested that care provided through synchronous telehealth is effective in improving outcomes for children with mental health conditions, but these studies are limited by pre- to post-intervention study designs and/or very small samples.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

Myers

Stoep

Zhou

et al. 2015

Journal of the American Academy of Child & Adolescent Psych

165

127

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Objective To test the effectiveness of a telehealth service delivery model for the treatment of children with attention-deficit/hyperactivity disorder (ADHD) that provided pharmacological treatment and caregiver behavior training. Method The Children’s ADHD Telemental Health Treatment Study (CATTS) was a randomized controlled trial with 223 children referred by 88 primary care providers (PCPs) in 7 communities. Children randomized to the experimental telehealth service model received 6 sessions over 22 weeks of combined pharmacotherapy, delivered by child psychiatrists through videoconferencing, and caregiver behavior training, provided in person by community therapists who were supervised remotely. Children randomized to the control service delivery model received treatment with their PCPs augmented with a telepsychiatry consultation. Outcomes were diagnostic criteria for ADHD and oppositional defiant disorder (ODD) and role performance on the Vanderbilt ADHD Rating Scale (VADRS) completed by caregivers (VADRS-Caregivers) and teachers (VADRS-Teachers) and impairment on the Columbia Impairment Scale-Parent Version (CIS-P). Measures were completed at 5 assessments over 25 weeks. Results Children in both service models improved. Children assigned to the telehealth service model improved significantly more than children in the augmented primary care arm for VADRS-Caregiver criteria for inattention (χ2[4]=19.47, p<.001), hyperactivity (χ2[4]=11.91, p=0.02), combined ADHD (χ2[4]=14.90, p=0.005), ODD (χ2[4]=10.05, p=0.04), and VADRS-Caregiver role performance (χ2 [4]=12.40, p=0.01) and CIS-P impairment (χ2[4]=20.52, p<.001). For the VADRS-Teacher diagnostic criteria, children in the telehealth service model had significantly more improvement in hyperactivity (χ2[4]=11.28, p=0.02) and combined ADHD (χ2[4]=9.72, p=0.045). Conclusion The CATTS trial demonstrated the effectiveness of a telehealth service model to treat ADHD in communities with limited access to specialty mental health services. Clinical trial registration information Children’s Attention Deficit Disorder With Hyperactivity (ADHD) Telemental Health Treatment Study; http://clinicaltrials.gov; NCT00830700.

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“…14-17 Telemental health (TMH) refers to the use of videoteleconferencing (VTC) to render psychiatric and mental health care that usually is provided in-person. Published work on the use of TMH with children and adolescents is limited and focuses predominantly on program descriptions and reports of satisfaction of providers, 18, 19 parents, 20 youth. 21 Two small pre- to post- intervention outcome studies have been conducted to date.…”

Section: Introductionmentioning

confidence: 99%

Methodology for conducting the Children’s Attention-deficit Hyperactivity Disorder Telemental Health Treatment Study in multiple underserved communities

Stoep

Myers

2013

Clinical Trials

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Background Children who live in non-metropolitan communities are underserved by evidence-based mental health care and underrepresented in clinical trials of mental health services. Telemental Health (TMH), the use of videoteleconferencing (VTC) to provide care that is usually delivered in person, shows promise for helping to rectify these service disparities. Purpose The Children’s ADHD Telemental Health Treatment Study (CATTS) is a randomized controlled trial designed to test the effectiveness of TMH in providing treatment to children diagnosed with attention-deficit hyperactivity disorder (ADHD) who are living in underserved communities. In this paper we describe the methodologies we developed for the trial and lessons learned. Methods Children ages 5.5-12 years of age with ADHD were referred to CATTS by their primary care physicians (PCP’s). The test intervention group (Group A) received six telepsychiatry sessions followed by in-person caregiver behavioral training delivered by a local therapist who was trained and supervised remotely. A secure website was used to support decision-making by the telepsychiatrists, to facilitate real-time collaboration between the telepsychiatrists and community therapists, and communication with the PCP’s. The control group (Group B) received a single telepsychiatry consultation followed by treatment with their PCP’s who implemented the telepsychiatrists’ recommendations at their discretion. Caregivers completed five sets of questionnaires about children’s symptoms and functioning and their own levels of distress. Older children (aged 10-12 years) completed questionnaires about their symptoms and functioning. Teachers completed ADHD rating scales. Questionnaires were completed online through a secure portal from personal computers. Results Eighty-eight PCP’s in seven communities referred the 223 children who participated in the trial. Attrition was low (3%). Children in Group A completed an average of 5.3 of 6 scheduled sessions; 96% of children in Group B completed their telepsychiatry consultation. Parents in both groups completed an average of 4.8 of 5 assessments. Telepsychiatrists and therapists showed high adherence to treatment protocols. Lessons Learned TMH proved to be a viable means of providing evidence-based pharmacological services to children and of training local therapists in evidence-based caregiver behavioral management. Recruitment was enhanced by offering the control group a telepsychiatry consultation. To meet recruitment targets across multiple dispersed sites, we developed community-specific strategies. A dedicated scheduler was a critical staff role to coordinate the multiple sites, sessions, and clinicians. Trial implementation was easier with sites that shared an electronic medical record system with our research hub. Conclusions The CATTS study used methods and procedures to optimize inclusion of children living in multiple dispersed and underserved areas. These experiences should advance the development of technologies needed to recruit ...

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Feasibility, Acceptability, and Sustainability of Telepsychiatry for Children and Adolescents

Abstract: Telepsychiatry is a feasible and acceptable approach to providing psychiatric services to youths in underserved communities. Sustainability will depend on developing financial alternatives to fee-for-service, especially if caseloads emphasize publicly funded programs.

Cited by 94 publications

References 0 publications

Rationale and Considerations for the Internet-Based Delivery of Parent–Child Interaction Therapy

Rationale and Considerations for the Internet-Based Delivery of Parent–Child Interaction Therapy

Effectiveness of a Telehealth Service Delivery Model for Treating Attention-Deficit/Hyperactivity Disorder: A Community-Based Randomized Controlled Trial

Methodology for conducting the Children’s Attention-deficit Hyperactivity Disorder Telemental Health Treatment Study in multiple underserved communities

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