Editor's note: This article was sponsored by Seattle Children's Hospital.
Imagine waiting months for an appointment with a child psychiatrist or driving hundreds of miles for routine visits to your child’s behavioral health specialist. These scenarios are everyday realities for scores of parents, due to a shortage of pediatric mental health-care providers in our region and nationwide.
Thankfully, telehealth — or medical appointments that take place remotely via video conferencing — allows more patients to access timely behavioral health care, particularly in rural and underserved communities. A growing share of behavioral health providers now use telehealth to treat adult patients, because it works; research shows that telemedicine is convenient, cost-effective, and works as well as more traditional methods of mental health care.
But behavioral telehealth for kids hasn’t quite caught up. Compared to adult behavioral health providers, relatively few pediatric providers offer virtual visits. That leaves too many families forced to choose between waiting too long or driving too far for their child’s mental health care.
Last year, a team of healthcare experts set out to change that. In April 2018, emergency medicine physician Mark Lo, M.D. and telehealth program manager Sarah Orth, both of Seattle Children’s Hospital, established the Telehealth Direct to Consumer pilot program to help bridge the gap between telemedicine and pediatric behavioral health. The program initially served patients in Seattle Children’s Autism Center’s Pediatric Feeding, Biobehavioral and Medication Evaluation and Management programs. It has since expanded service to the Psychiatry and Behavioral Medicine, Neuropsychiatry, and the Program to Enhance Attention, Regulation and Learning (PEARL) clinics.
Over the program’s first 16 months, participating care teams met with 206 different patients during 546 video visits, saving families some 97,260 miles of driving to Seattle.
Over the program’s first 16 months, participating care teams met with 206 different patients during 546 video visits, saving families some 97,260 miles of driving to Seattle. Reduced driving time was far from the most significant benefit, however. Easing the challenge of coordinating multi-provider appointments relieved a significant administrative burden, allowing providers to see more patients and increasing access to care.
“Health care is no longer about the solo provider. A lot of these visits are multidisciplinary. You may have a mental health-care provider, a social worker, a dietician, or athletic trainer, several different ancillary services, or an interpreter,” says Lo. “As we coordinate all of this care for a single visit, telehealth has taken a bit of the burden out of scheduling these massive, multi-provider visits — providers don’t all have to be there in person at one time.”
The program yielded some surprising benefits, too. Providers found that telehealth provided unique insights into a patient’s living environment that often benefited their treatment, says Lo. By enabling providers to see parts of a patient’s living space, videoconferencing helped care teams devise more effective treatments for persistent problems.
“One thing that did surprise me when we started doing home telemedicine visits is the insight that we’d gain by seeing our patient’s home environment,” he notes. “For example, with our feeding clinics, we’d be able to understand why a proposed intervention wasn’t working, because we could see how a patient’s home was set up, and then we could propose a different management system based on that information.”
Treating pediatric patients via telehealth presents unique challenges around patient privacy, Lo notes. Because telehealth gives providers less control over who may be in the room during treatment, ensuring that patients and their families understand safety and privacy protocols is essential. “One of the challenges of tele-psychiatry for people who are minors is figuring out how the family is going to be involved. In a clinic environment, we’d be able to go through the safety protocols with parents or caretakers, and ask them to step outside of the room when needed. With telehealth, when we’re speaking to a minor patient at home, it’s a less controlled environment.”
Overcoming these challenges helps improve access to care for pediatric patients in Puget Sound and beyond. Just as importantly, pediatric patients can spend less time traveling to health-care appointments, and more time just being kids. ‘’Pediatric telemedicine is coming along,” notes Lo. “I think adult telemedicine has paved the way, and I think we’ll be able to take some of those findings and use them to advance telemedicine for pediatric populations.’’
Learn more about psychiatry and behavioral medicine services available at Seattle Children’s.