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  1. 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. 2. GOALS Discuss the Rationale for Child Telepsychiatry Discuss Our Service Model Explore Child Specific Telepsychiatry Approaches Show Results of Pilot Satisfaction Survey
  3. 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. 4. COMPLETED Child and Adolescent Psychiatry Visits Since 2007 via telepsychiatry: > 4500
  5. 5. FACILITIES Based in our Out Patient Clinic 2 Offices Dedicated and FullyTelemedicine Equipped Technical Support from UVA Telemedicine Office Partner with CSBs
  6. 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. 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. 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. 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
  11. 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. 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. 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. 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
  17. 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.