Supporting Primary Care Through Pediatric Telepsychiatry (original) (raw)
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Child and Youth Telepsychiatry in Rural and Remote Primary Care
Child and Adolescent Psychiatric Clinics of North America, 2011
The recent proliferation of live interactive videoconferencing technology has made it possible for 2 or more individuals at any distance apart to interact in real time. Telepsychiatry is a specific term designating psychiatric applications using videoconferencing communication 1 and is emerging as one of the most successful uses of this technology. 2,3 Telepsychiatry has important implications for accessing pediatric subspecialty services and in determining future health care workforce requirements
Child and adolescent telepsychiatry in New South Wales: moving beyond clinical consultation
Australasian Psychiatry, 2003
Objectives: Telepsychiatry has been demonstrated to be an effective and acceptable way to deliver psychiatry services to remote and rural areas. This paper describes the initial evaluation of the Child and Adolescent Psychological Telemedicine Outreach Service (CAPTOS) in New South Wales and the changes made to the service after the initial evaluation. Methods: The evaluation investigated patients', rural clinicians' and CAPTOS psychiatrists' satisfaction with the quality of the service and the technology. Results: There were 136 rural families, 20 rural clinicians and eight psychiatrists. Overall, satisfaction was high with the rural families and clinicians being the most satisfied (95-99% very or mostly satisfied). CAPTOS psychiatrists felt that they were usually able to perform an adequate consultation (87%) but few (16%) felt the consultations were as satisfactory as a face to face consultation. Because of the initial evaluation, and the ongoing collaboration with rural clinicians, further services were developed using the technology and the developing professional networks. These initiatives included telenursing, professional skills development, sabbaticals for rural clinicians and a clinical skills workshop for rural clinicians. Conclusions: This study confirms telepsychiatry as a useful service for remote and rural children and families. The results also suggest some reasons why urban clinicians show the least enthusiasm for the service. Ways of addressing some of the limitations of the service are suggested, and the expansion of CAPTOS to meet the needs of rural clinicians is discussed.
Child Psychiatry Use of Telepsychiatry for Child Psychiatric Issues: First 500 Cases
In 2000, the Division of Child Psychiatry of the University of Toronto was awarded a one-year contract with a two-year renewal to establish a telepsychiatry program with the objective of strengthening mental health services to children and their families throughout rural and northern Ontario. We describe the program, including data from the first 500 consultations, a brief summary of educational activities and the approach taken to evaluate service efficacy.
Models of telepsychiatric consultation-liaison service to rural primary care
…, 2006
New models of psychiatric intervention are needed to improve the accessibility of mental health care in the primary-care setting, particularly in rural areas of the United States. Some models of service delivery have been successful in suburban and urban settings, but they do not always apply to rural settings. "E-health" innovations like videoconferencing, telephone, secure messaging (e-mail), and the Internet are increasingly being used to provide consultation-liaison service to primary care. This article briefly reviews successful models used in primary care, their application to rural sites, new models for rural sites, and suggestions for future e-health research.
Clinical Use of Telemedicine in Child Psychiatry
FOCUS, 2008
The national shortage of child psychiatrists has left many children without access to treatment. Telepsychiatry can extend the reach of child psychiatry by providing consultative care to children at a distance. The authors provide a definition of telepsychiatry, a review of the limited published child research in the area, and a child telepsychiatry clinic model. The value of child telepsychiatry is emphasized, as well as the need for standardized practice and research. Despite the need for expanding child psychiatric services, telepsychiatry has been used primarily in adult psychiatric practice. Efforts to use this medium in child psychiatry are limited. There are fewer than 8,000 child psychiatrists in the United States and a limited number in child psychiatry fellowship training; the Surgeon General estimates that less than 20% of the 13.7 million children and adolescents in need of treatment for mental illness receive care (1). Similar to adult rates, 20% of children and adolescents in the United States are estimated to have emotional and behavioral disorders. Suicide was the third leading cause of death among children aged 10-24 in 2004 (2), and there is evidence of even higher suicide rates among children in rural areas (3, 4). Calloway et al. (5) noted several articles reporting that rural youth receive fewer mental health services than urban youth. Almost three-fourths of smaller rural counties with populations of 2,500-20,000 lack a psychiatrist and 95% lack a child psychiatrist. Consequently, children in these regions with serious mental health problems are among the most disadvantaged in receiving care (6). The use of videoconferencing technology gives specialists a means of providing care at a distance. Its application would improve the quality of treatment, reduce its cost, and clearly create accessibility for patients (7). Telemedicine applied to psychiatry is defined as the use of electronic communication and information technologies in order to provide or support its application of clinical psychiatric care at a distance (2). Videoconferencing technologies enables a real-time patient and a mental health professional to simultaneously connect with one or more primary sites
Pediatric Telepsychiatry as Innovation in Healthcare Delivery
Concepts, Methodologies, Tools, and Applications
Although a great deal has been written about the potential for telemedicine to increase access to care, applications in paediatrics are sparse. This chapter details how one paediatric telepsychiatry program has facilitated the creation of integrated healthcare solutions in patient psychiatric care for children and youth in remote and rural communities. It demonstrates how the telepsychiatry model of healthcare service delivery has improved access, enhanced capacity, and promoted knowledge exchange in rural communities. A case study is used to highlight theoretical and empirical research on the value of televideo information technology in mental healthcare and its impact on the healthcare stakeholders who utilize this technology. An overview of the clinical, education, and evaluation components of the program is outlined, with a focus on knowledge translation and exchange as the underpinning foundation to the success of the program.
Rural telepsychology services for children and adolescents
Journal of Clinical Psychology, 2010
Because of the overwhelming maldistribution of mental health specialists in metropolitan areas and the many underserved families living in rural settings, rural areas are natural homes for the use of telemedicine or videoconferencing technology for clinical services. The authors describe telepsychology services for rural clients, placing best psychology practices within the context of broader telemental health services. The goal is to approximate evidence-based child psychotherapy from face-to-face practice using the videoconferencing technology. Telepsychology is illustrated with a case report of a rural Hispanic teen and her family presenting through the teen's primary care clinic. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66:1–12, 2010.
JMIR Public Health and Surveillance
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.
Clinical Use of Telemedicine in Child
2008
The national shortage of child psychiatrists has left many children without access to treatment. Telepsychiatry can extend the reach of child psychiatry by providing consultative care to children at a distance. The authors provide a definition of telepsychiatry, a review of the limited published child research in the area, and a child telepsychiatry clinic model. The value of child telepsychiatry is emphasized, as well as the need for standardized practice and research. Despite the need for expanding child psychiatric services, telepsychiatry has been used primarily in adult psychiatric practice. Efforts to use this medium in child psychiatry are limited. There are fewer than 8,000 child psychiatrists in the United States and a limited number in child psychiatry fellowship training; the Surgeon General estimates that less than 20% of the 13.7 million children and adolescents in need of treatment for mental illness receive care (1). Similar to adult rates, 20% of children and adolescents in the United States are estimated to have emotional and behavioral disorders. Suicide was the third leading cause of death among children aged 10-24 in 2004 (2), and there is evidence of even higher suicide rates among children in rural areas (3, 4). Calloway et al. (5) noted several articles reporting that rural youth receive fewer mental health services than urban youth. Almost three-fourths of smaller rural counties with populations of 2,500-20,000 lack a psychiatrist and 95% lack a child psychiatrist. Consequently, children in these regions with serious mental health problems are among the most disadvantaged in receiving care (6). The use of videoconferencing technology gives specialists a means of providing care at a distance. Its application would improve the quality of treatment, reduce its cost, and clearly create accessibility for patients (7). Telemedicine applied to psychiatry is defined as the use of electronic communication and information technologies in order to provide or support its application of clinical psychiatric care at a distance (2). Videoconferencing technologies enables a real-time patient and a mental health professional to simultaneously connect with one or more primary sites