1. TELEPSYCHIATRY
With Children and Adolescents
Roger C. Burket, M.D.
Child and Family Psychiatry
Developmental Disorders Section
UVA Department of Psychiatry and
Neurobehavioral Sciences

2. GOALS
Discuss the Rationale for Child
Telepsychiatry
Discuss Our Service Model
Explore Child Specific
Telepsychiatry Approaches
Show Results of Pilot Satisfaction
Survey

3. RATIONALE
Child Psychiatry is the most underserved medical
specialty.
Most rural areas in the US (and Virginia) are
without, or underserved for child psychiatric
services.
Many urban areas also lack sufficient services.
Complicated diagnostic and medication issues can
stress primary care providers (Family Practice,
Pediatrics).
Long commutes to treatment sites are costly and
lead to school absences

4. COMPLETED
Child and Adolescent Psychiatry Visits
Since 2007 via telepsychiatry:
> 4500

5. FACILITIES
Based in our Out Patient Clinic
2 Offices Dedicated and
FullyTelemedicine Equipped
Technical Support from UVA
Telemedicine Office
Partner with CSBs

6. SERVICES PROVIDED
Initial Child Psych Evaluations
Medication Follow-Up Visits and
Management
24/7 On Call for Urgent Medication Issues
Necessary Administrative Support and
Record Management
Care Supervised by 2 board certified
Child Psychiatrists

7. Working With Children Via
Telepsychiatry
Office Environment
Telemedicine office should look like a typical therapy
office
Treatment site should be large enough for parents and
staff to sit comfortably
Therapist should appear on screen like a newscaster
Building Rapport
Wave to child on greeting and ending
Perhaps zooming camera out to allow child to see more
of the office
Slightly exaggerate gestures (but don’t move too fast)
Look directly at camera occasionally to approximate
eye contact

8. Working With Children Via
Telepsychiatry
Conduct of interview
Guardian must be present
Be sure supporting documents and records are
available
Ask initially if patient and parent are seeing and hearing
you well
Speak deliberately and with some animation
Often it helps to let the parent of a younger child take
the lead initially
But, keep the child involved periodically
Try to talk to adolescents and most children alone if
possible
The standard psychiatric interview techniques work !
Encourage children and adolescents to ask questions

9. PILOT SURVEY
21 question anonymous survey
completed by parents (n = 48)
Agreement with various aspects of their
telepsychiatry experience were rated on
a 5 point likert-type scale
1 = strongly agree
2 = agree 3 = neutral
4 = disagree
5 = strongly disagree
Wiseman BL, Burket R, Tucker JB: “Telemedicine and Child
and Adolescent Psychiatry.” American Academy of Child and
Adolescent Psychiatry, Scientific Proceedings-Annual Meeting
- Poster Session – Chicago, IL, Oct 2008

10. SAMPLE DIAGNOSES

11. SURVEY RESULTS
Questions n Mean S. D.
I was able to see the psychiatrist well. 48 1.52 0.74
I was able to hear the psychiatrist well. 48 1.42 0.54
The office staff at my local facility is helpful and efficient. 48 1.46 0.54
I had ample opportunity to ask questions during this visit. 48 1.48 0.55
The telemedicine office was comfortable. 47 1.47 0.58
The screen allowed me to see the physician in sufficient detail. 47 1.60 0.68

12. SURVEY RESULTS
Questions n Mean S. D.
There were no problems with the equipment during this visit. 46 1.70 0.89
My child is comfortable using computers and other electronic devices. 45 1.58 0.66
My child was comfortable with the videoconferencing format of the visit 47 1.64 0.61
I felt uncomfortable or intimidated during this visit. 46 4.11 1.16
My child experienced more anxiety during the telemedicine visit than he/she does
at in-person healthcare visits. 46 3.93 1.10

13. SURVEY RESULTS
Questions n Mean S. D.
The teleconferencing technology interfered with the communication between the
doctor and patient. 46 4.04 1.15
If not for the telemedicine service, my child would probably not be receiving care
from a psychiatrist. 46 2.17 1.39
Using the telemedicine facility saved me time and/or money versus driving to a
more distant in-person visit. 47 1.47 0.88
I am pleased with the care my child received at this visit 44 1.50 0.55
I would prefer to see a child psychiatrist in person instead of using telemedicine. 43 3.70 1.19

14. SURVEY RESULTS
Questions n Mean S. D.
I would recommend telemedicine to other parents. 42 1.45 0.63
My child received the same level of service through telemedicine at previous in-
person visits with physicians. 42 1.95 1.01
The use of video conferencing made my child more comfortable talking with the
psychiatrist than in face-to-face office visits. 41 2.34 0.99
The psychiatrist understood my child’s problems well. 44 1.80 0.70
The psychiatrist and the staff at the telemedicine clinic worked well together. 43 1.49 0.67

15. SURVEY RESULTS

16. SURVEY RESULTS

17. CONCLUSIONS
Telepsychiatry can help meet the needs
of children with mental health issues in
underserved areas.
Current technology works well.
Standard psychiatric evaluation and
treatment techniques work with only
minor adjustments.
Telepsychiatry is generally well received
by children and their parents.