On April 10, the American Telemedicine Association (ATA) released new practice guidelines for child and adolescent telemental health services that will positively shape the provision of mental and behavioral health care to children through telehealth.
The guidelines were created to assist providers in delivering safe, effective telemental health care. I applaud the American Telemedicine Association for creating and releasing these guidelines which help set the standards for appropriate care and further validate the practice of telemental health for treating children.
As a child and adolescent telepsychiatrist for the past 18 years, I have treated children in a variety of different settings telehealth. Developmental and environmental factors play a huge role in diagnoses and treatment considerations for children. Much of the assessment work for children relies on observation of interactions, motor activity and exploratory skills rather than the dialogue about mental health status that is characteristic of adult psychiatry. Child and adolescent telemental health requires more physical space for assessments, higher camera functionality for observations and the presence of parents, caretakers and/or other facilitators.
Of the 20% of children and adolescents, ages 9-17, in the U.S. that have diagnosable psychiatric disorders, many do not receive interventions largely due to huge the shortage of child and adolescent psychiatrists. There are only 8,200 practicing child and adolescent psychiatry providers in the U.S., a shortage that is felt in the areas of the country that need care the most. My home state of New Jersey alone would need three times the number of child and adolescent psychiatrists than they currently have to meet the needs of the kids in the state, which doesn’t account for the need of better distribution of these providers.
In addressing these disparities and increasing young people’s access to mental health care, telepsychiatry is a great solution for extending the existing child and adolescent mental health workforce and getting mental health services to the kids who need it.
The new ATA guidelines offer suggestions and requirements on administrative, legal, regulatory and general telemental health practice procedures, as well as standards for technology use and dealing with various cases including emergencies.
These guidelines were spearheaded by Dr. Kathleen Myers and Dr. Eve-Lynn Nelson who served as co-chairs for the Telemental Health with Children and Adolescents work group alongside members Dr. Donald Hilty and Dr. Terry Rabinowitz. InSight Telepsychiatry’s Executive Director, and I, along with many other mental health providers and members of the ATA Telemental Health Special Interest Group had the opportunity to contribute to and review the guidelines.
The following are some of the key subject areas within the new guidelines.
Physical Location/Telemental Health Space
The physical space for the telemental health assessment plays a larger role in child and adolescent psychiatry than in adult psychiatry. Rooms should comfortably fit the child and one to two adults, but not be so big that the child can wander out of the camera view. Additional elements to consider include proper lighting, adequate equipment and communication about who is in the room.
Presenter Assistance in Telemental Health Sessions
The guidelines recommend a presenter be in the room during appointments to act as a third party to help with anything the remote provider may need to conduct an evaluation.
Providers should carefully review federal and state guidelines regarding prescribing through telemental health, especially for children.
Telemental Health Competencies
The guidelines urge providers to remain curious about telemental health technology and best practices and encourages providers to seek regular education and trainings on telemental health.
As telemental health progresses, new challenges will continue, but more importantly, there will be opportunities to increase mental healthcare access to the young people who need it.
Thank you to the ATA Telemental Health Special Interest Group and the authors of these guidelines for recognizing the importance of this topic.
I encourage all providers who are currently using telehealth to work with children and all providers who may be interested in child and adolescent telemental health in the future to review the guidelines and consider how to adapt the lessons within it to their own practice and style.
I also encourage training programs who are educating the future mental health workforce to review these guidelines and work their lessons into their curriculum. Telehealth will undoubtedly be a part of their practice in some way in the future and should be standard part of training.
The American Academy of Child and Adolescent Psychiatry also has a guideline for telemental health that was released in 2014.
Read the ATA’s Child and Adolescent Telemental Health guidelines here or find other recent telehealth guidelines for other disciplines on the ATA resources page.