Rural Child and Adolescent Telepsychiatry: Successes and Struggles

Abstract

<P>Research consistently shows that as many as one in five children and adolescents have mental health problems, and primary care providers (PCPs) identify 19% of children with behavioral and emotional disorders. Although these providers frequently refer children for mental health treatment, significant barriers exist to referral, including lack of available specialists, insurance restrictions, appointments delays, and stigma. Approximately 25% of the population lives in rural settings, and rural departments of health report an even greater problem with access to specialists for rural residents than their urban counterparts. In adults, and probably children and adolescents, the lack of mental health services leads to undertreatment, poor outcomes such as higher rates of suicide and homicide, as well as increased use of emergency services, hospitalizations, and placement in mental health institutions.</P><H4>ABOUT THE AUTHORS</H4><P>Donald M. Hilty, MD, is Professor of Psychiatry and Behavioral Sciences, and Director, Rural Program in Medical Education (Rural-PRIME), UC Davis School of Medicine and Medical Center. Peter M. Yellowlees, MD, MRCP, is Professor of Clinical Psychiatry and Behavioral Sciences and Director of Academic Information Systems, UC Davis School of Medicine and Medical Center. Priya Sonik, MD, is Resident of Psychiatry and Behavioral Sciences, UC Davis School of Medicine and Medical Center. Mikla Derlet, MD, is Assistant Clinical Professor of Pediatrics, UC Davis School of Medicine and Medical Center. Robert L. Hendren, DO, is Professor of Psychiatry and Behavioral Sciences, and Chief; Child and Adolescent Psychiatry; Tsakopoulos-Vismara Chair and Executive Director, M.I.N.D. Institute, UC Davis School of Medicine and Medical Center.</P><P>Address correspondence to: Donald M. Hilty, MD, Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA 95817; fax: 916-734-3384; or e-mail <A HREF="MAILTO:dmhilty@ucdavis.edu">dmhilty@ucdavis.edu</a>. </P><P>Dr. Hilty; Dr. Yellowlees; Dr. Sonik; Dr. Derlet; and Dr. Hendren have disclosed no relevant financial relationships.</P>

Child and adolescent mental health service providers’ perceptions of using telehealth

“…The limited access to age appropriate mental healthcare means that the child or young person is less likely to promptly see a CAMHS specialist or take part in appropriate social or educational activities. The reduced opportunities to benefit from needed interventions, results in less than optimal care and may have a lasting effect on the well being of the child or their family (Hilty et al, 2009). This is especially true for those with high levels of symptoms, disabilities and difficulties in management associated with psychiatric diagnosis -in remote and rural parts of the UK.…”

Adoption of technology‐enhanced treatments: Conceptual and practical considerations.

“…In addition to access, clinicians and service settings also cite funding, including for third‐party reimbursement of services, as a major barrier to the adoption of technology enhancements (Gershkovich et al., ; Mora, Nevid, & Chaplin, ; Perle et al., ; Salloum et al., ). Yet, relatively few studies actually report cost data, and those that do often fail to report costs in a systematic, translatable, or digestible way (for reviews, see Hilty, Yellowlees, Sonik, Derlet, & Hendren, ; Jones, ). Similarly, clinicians indicate that the sustainability of technology enhancements depends on funding, as well as time, for comprehensive training and ongoing, consistent supervision and support (e.g., Glisson, ; Schoenwald & Hoagwood, ; Southam‐Gerow, Rodríguez, Chorpita, & Daleiden, ).…”

Attitudes towards video consultation for telepsychiatry services among psychiatrists during the COVID-19 pandemic: An observational study

“…In view of the multiple proven advantages of telepsychiatry, it is of clinical interest to better understand the attitudes of health care providers towards this health care delivery modality. Though few studies have examined this question ( Hilty et al, 2009 ; Mucic, 2008 ; Saeed et al, 2012 ), to the best of our knowledge, there are none in the Indian context. This study aims to address this lacuna as well as provide valuable inputs for acceptance of telepsychiatry services among psychiatrists in the context of the COVID-19 pandemic.…”