Mental health services for children and youth: a survey of physicians' knowledge, attitudes and use of telehealth services

Abstract

Rural physicians in Ontario, whose practice included children, were surveyed on their awareness, attitudes and use of telemental health services for children and young people in their region. Of 95 rural physicians, 70 completed and returned the telehealth section of the survey (74% response rate). The survey comprised 14 questions. Only 27% of responders were aware of the available videoconferencing services. The proportion of physicians who reported having referred patients for the various mental health services through videoconferencing was 0-24%. The proportion of physicians who reported that they would refer patients through videoconferencing was 55-92%. Reduced travel time and care provided closer to home were seen as the primary benefits of referring patients to mental health services through videoconferencing. Unclear referral patterns and technology compromises were seen as limitations of referring patients to videoconferencing. Access to rural populations and improved access to patients were seen as benefits to practice, and undeveloped remuneration procedures as the primary limitation. Promotion may be important to successful implementation of telemental health services for children and young people.

Barriers to Use of Telepsychiatry: Clinicians as Gatekeepers

“…It is also possible for the patient to literally "switch off" the therapist. 69,77,89 SAFETY Clinicians and patients have expressed concerns about securing safety for patients in crisis or faced with the threat of selfharm. 9,16,33,34,38,46,49,52, [77][78][79][80] Patients have Case example: Telepsychiatry was provided to an inpatient hospital to cover for physician illness.…”

“…91,92 Unfortunately, previous studies abound with examples of technical difficulties such as sessions unable to start, spontaneous disconnections, or poor audio/visual quality, and audio/visual lag. 11,33,[38][39][40]44,51,54,[64][65][66][67]89,[93][94][95] When technology works poorly, technical support becomes an additional factor deserving consideration. 20,21,31,51 Adequate transmission speed (at least 384 kbps) and adequate bandwidth are needed to support ability to detect facial cues, and without lag that can result in a jerky video.…”

“…Limited education, clinical exposure, and hands-on learning in telepsychiatry are significant barriers to expanding use. 8,11,20,27,28,31,35,38,40,47,59,89,104,105,[107][108][109][110] Telepsychiatry education in medical school and residency is minimal, 8,47,110 with only 21 of 183 US residency training programs offering any training or experience in telepsychiatry. 12 The burden largely falls on individual psychiatrists to seek out the knowledge and experience required to become competent in telepsychiatry.…”

Child and Youth Mental Health Service Referrals: Physicians' Knowledge of Mental Health Services and Perceptions of a Centralized Intake Model

“…Thirdly, we surveyed physicians' attitudes and knowledge of mental healthcare provided by telehealth. The results of the telehealth portion of the survey are presented elsewhere (Cloutier et al 2008). …”

Referrals for pediatric weight management: the importance of proximity

“…Therefore, alternative forms of communication (i.e., videoconferencing) may be more practical for families and clinicians, regardless of treatment modality. Although these technologies hold promise [15-17], additional research is needed to evaluate the effectiveness of e-health interventions to improve process and clinical outcomes in pediatric weight management.…”