Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study

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.

‘It’s not like real therapy’: young people receiving child welfare services’ experiences of video consultations in mental healthcare in Norway: a mixed methods approach

“…Ten of these participants had experiences with VC. The in-depth interviews with these ten young persons (aged [15][16][17][18][19] The participants could choose if they wanted to do the interview in-person or online. Participants were asked about their experiences of VC in questions like: 'Have your received VC from CAMHS?'…”

“…Of these 36, 69% (n = 25) were girls, 28% (n = 10) were boys, and 3% (n = 1) identified as 'other' . The mean age of this group was 19 years (SD = 1.78, range [16][17][18][19][20][21][22][23][24]. Six of them lived in a childcare facility, ten lived with foster parents, four with one or both parents, four with friends, in a group or with another family member, eight lived alone in studio flats, and three in other kinds of housing.…”

“…Several studies show, paradoxically, that these young people often have poorer access to mental health services [12][13][14][15][16][17]. There has been a focus on how mental health services can reach this group, and VC has been suggested as an innovative solution [18,19]. The concern that young people receiving CWS were particularly vulnerable during COVID-19 further accentuated the need for CAMHS to maintain contact with them [20][21][22].…”

“…Studies indicate that VC can improve access to specialist mental healthcare by lowering important barriers like geographical distance, low socio-economic background and poverty [18,19,23]. However, structural inequality in access to technological solutions and disparities in knowledge of digital tools have been highlighted [9,21,24,25].…”

“…Several studies of service providers' perspectives indicate promising results and positive experiences of VC in mental health treatment for young people [2,18,19,23,27]. The review by Boydell et al [2] suggests that young people may be more likely to respond to VC and internet-based applications.…”