Question 1

Has research been done to prove child & adolescent telepsychiatry works? What’s the evidence base?

Accepted Answer

Yes, children, adolescents, and families can benefit from telepsychiatry. In a variety of mental health conditions such as ADHD, autism, and OCD, studies have indicated that video visits are useful in accessing psychiatric specialists and improving symptoms.

In attention deficit hyperactivity disorder (ADHD) studies with telepsychiatry, for instance, improvement in hyperactivity and combined ADHD has been shown in hundreds of children in randomized clinical trials, combining video visits with child psychiatrists along with caregiver behavior, versus treatment with their primary care providers augmented with telepsychiatry consults. In autism, clinicians can use telepsychiatry videoconferencing for diagnosis & assessment. And, in obsessive-compulsive disorder (OCD), video visits reduced symptoms versus a waitlist control in a randomized clinical trial.

We additionally see video visits used to give behavioral parent training, with live therapists, showing treatment response and improvements in children ’s symptoms as well as easing of parental burden. Video visits can also help with parental coaching for children with autism, to help conduct home assessments, and for communication coaching.

The American Academy of Child and Adolescent Psychiatry provides expert guidance on how to deliver psychiatric services to this population, including optimizing clinical visits. This guidance is assembled by experts on the Committee on Telepsychiatry and the Committee on Quality Issues.

Sources:

Myers K, vander Stoep A, Zhou C, et al. Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: results of a community-based randomized controlled trial. J Amer Asso Child Adolesc Psychiatry 2015;54(4):263-74.
American Academy of Child and Adolescent Psychiatry Committee on Telepsychiatry and the Committee on Quality Issues. Clinical Update for Telepsychiatry with Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry. 2017;56(10):875–893.
Comer JS, Furr JM, Miguel E, Cooper-Vince CE, Carpenter AL, …Myers KM & Chase R. Remotely delivering real-time parent training to the home: An initial randomized trial of Internet-delivered Parent-Child Interaction Therapy (I-PCIT). Journal of Consulting and Clinical Psychology. 2017; 85 (9): 909–917.
Lee JF, Schieltz KM, Suess AN, Wacker DP, Romani PW, Lindgren SD, Kopelman TG, Padilla Dalmau YC. Guidelines for developing telehealth services and troubleshooting problems with telehealth technology when coaching parents to conduct functional analyses and functional communication training in their homes. Behavior Analysis Practice DOI 10.1007/s40617-014-0031-2; Published online 27 November 2014.
Myers K and Roth DE. Telepsychiatry with children and adolescents. In: Martin A, Volkmar FR, and Bloch MH (Eds), Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 5th Edition. Wolters Kluwer, Philadelphia, 2018; Chapter 6.3.5.
Reese RM, Jamison R, Wendland M, Fleming K, Braun MJ, Schuttler JO et al. Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine and J E Health. 2013;19(9):671-677.
Storch EA, Caporino NE, Morgan JR, Lewin AB, Rojas A, Brauer L et al. Preliminary investigation of web-camera delivered cognitive-behavioral therapy for youth with obsessive-compulsive disorder. Psychiatry Research. 2011;189(3):407-412.
Vander Stoep A, McCarty C, Zhou C, Rockhill CM, Schoenfelder E, Myers K. The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: caregivers’ outcomes. Journal of Abnormal Child Psychology. 2016; 45(1):27-43.

Question 2

What is the standard of care for telepsychiatry and/or telemedicine?

Accepted Answer

What is the Standard of Care for Telepsychiatry?

Telehealth is increasingly being adopted by providers, patients, hospitals, and clinics as a great way of providing access to much needed healthcare. Policymakers and lawmakers have generally fallen behind the current practice and therefore there can be some uncertainty around what standard of care should apply.

Moreover, “Standard of care” can be subject to interpretation based on several factors, including, but not limited to:

• Specialty or subspecialty, as it relates to the scope of practice of the provider

Notably, the applicable community is debatable in telehealth, as the doctor and patient care are in different geographic areas.

Each state may have its own opinions about standards of care for telehealth and multiple jurisdictions can potentially apply. In some, but not all states, the state medical board has language that states that standard of care for telemedicine is considered the same or similar to in person care.

As a provider, the best way to think about standard of care is to do what a reasonable and prudent provider do in similar circumstances. Reasonable and prudent care often depends on several components, such as:

• Patient case factors- although there are no absolute contraindications for telehealth, in rare cases the patient might object to the use of the technology for reasons such as paranoia/fear about being recorded or the technology being hacked, or difficulty keeping themselves in the frame of the camera due to cognitive issues. Also, if the patient is intellectually disabled and does not understand what is going on, perhaps thinking that they are watching TV.

• Setting to which care is being delivered- the environment is noisy, distracting, or not private, this can affect the quality of care provided.

• Types of technologies being used- if the technology does not allow adequate audio or video, this brings down the quality of assessment and treatment.

• Overall framework in which care is being provided- If telepsychiatry is conducted in the absence of other potentially important support for the patient

• Consent- consent requirements are determined by each state. Some states require specific verbal or written consent from the patient to conduct appointments via telehealth. Others do not have this requirement or have not opined on it.

• Limitations around AIMS testing. There are ways to conduct AIMS testing remotely, although the provider should be cognizant of potential limitations and this should be factored in the standard of care.

Ultimately, standards of care can be interpreted in a variety of ways, and telehealth makes it even more vague and sometimes confusing. Therefore, the provider should use their best judgment, considering clinical factors, their means to resources, and the overall nature of the care being provided.

Disclaimer- this article is our best effort to provide useful information and does not constitute legal advice. Please make sure to consult with entities such as state medical boards, their malpractice carrier, and potentially legal counsel prior to practicing healthcare.

Question 3

I need help.

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us.

However, if you are a patient seeking services for yourself or your family/friend, Orbit Health cannot provide care directly to you. If this is a medical or mental health emergency, please call 911 or go to an emergency room immediately.

Immediate help

Get immediate help through MentalHealth.gov's Immediate Help page.
If you or someone you know is suicidal or in emotional distress, contact the National Suicide Prevention Lifeline. This service is available 24 hours a day, 7 days a week. Staffed by trained crisis workers.
Are you a veteran in crisis? The Veterans Crisis Line is available 24/7 — by phone, text message, and online chat.

Learn more

Find out how to get help at MentalHealth.gov
Find a psychiatrist, and learn more about psychiatric topics, at the American Psychiatric Association
Learn how to find mental health help at Mental Health America

Question 4

I need a psychiatrist

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us through our website,https://www.orbithealth.com/contact-us/ However, if you are a patient seeking services for yourself or your family/friend, we cannot provide care directly to you. If this is a medical or mental health emergency, please call 911 or go to an emergency room immediately.

Question 5

I need a psychologist

Accepted Answer

If you are an administrator seeking services for your healthcare organization or facility, please contact us through our website,https://www.orbithealth.com/contact-us/ However, if you are a patient seeking services for yourself or your family/friend, we cannot provide care directly to you. If this is a medical or mental health emergency, please call 911 or go to an emergency room immediately.

Question 6

Is telepsychiatry subject to specific guidelines and laws?

Accepted Answer

Orbit Health psychiatric professionals strictly adhere to the federal and state guidelines that apply to their practices. Additionally, different states may implement and apply different guidelines specific to telepsychiatry.

For example, telepsychiatry practitioners must carefully follow laws that regulate prescriptions for controlled substances. This is done by a rule called the “Ryan Haight Online Pharmacy Consumer Protection Act of 2008,” enforced by the DEA (Drug Enforcement Agency).

The Ryan Haight Act requires a practitioner to conduct in-person medical evaluation before they can prescribe a controlled substance. Some exceptions apply for systems like federal healthcare providers at Indian Health System.

With the COVID-19 public health emergency, an in-person medical evaluation is not feasible. This is where telepsychiatry has a protective advantage for clinical staff and for patients. For instance, the DEA will allow prescriptions to be issued for audiovisual telemedicine communication.

Question 7

Is special software and training needed?

Accepted Answer

When you contract with Orbit Health, we will provide your medical practice with all of the software and training necessary to implement our telepsychiatry services. The process is simple and requires very little setup.

Question 8

Where do patients receive treatment?

Accepted Answer

Patients can visit their local clinic, medical office, or hospital. Wherever you can set up a private space for video conferencing, patients can comfortably sit and engage with our mental health professionals.

Question 9

Can medication be prescribed via telepsychiatry?

Accepted Answer

Yes. Our licensed psychiatrists are able to prescribe medications for patients they diagnose and treat remotely. Our providers will write and sign the prescriptions, which can then be transmitted to the clinic for local fulfilment.

Question 10

Is telepsychiatry as effective as in-person sessions?

Accepted Answer

The psychiatric professionals at Orbit Health are among the best in the industry. They can provide clinical diagnoses, treatments, and effective outcomes, as well as increase community health in wellness, especially in underserved areas.

The lack of physical proximity does not inhibit our experts’ ability to diagnose and treat patients suffering from any number of psychiatric conditions. The level of privacy and confidentiality is the same as in-person care.

Research shows that telepsychiatry is just as effective as in-person, face-to-face care. Many patients, in fact, find that psychiatric treatment via videoconferencing is less intimidating or embarrassing. Patients, psychiatrists, and other professionals have all reported high levels of satisfaction with telepsychiatry since its inception.