Telehealth for Kids

Whether your child already receives mental health treatment or you’re working on finding them treatment, chances are that the coronavirus crisis has thrown a wrench into your plans. But while in-person sessions aren’t possible right now, many providers are now offering mental health services online.

The crisis has prompted many mental health professionals across the country to begin seeing patients virtually. For patients they were already seeing, it provides support and continuity. “What we’re doing is really trying to keep things as consistent as we can,” says Joanna Stern, PsyD, a clinical psychologist at the Child Mind Institute. “There are so many things that we don’t have control over, that are changing, so let’s keep this touch point.”

But the expansion of telehealth services also means that if you live in an area with few mental health professionals, you may now have much greater access to care for your child.

Here’s a guide to making the most of telehealth for your child’s mental health treatment. To learn more about telehealth, you can also read our 2020 Children’s Mental Health Report, which offers an overview of the latest research.

Telehealth is essentially a session with a health provider that happens via technology instead of in person. In mental health treatment, that could include a diagnostic evaluation or a treatment session. Video calls are the most common medium, but telehealth sessions can also happen over the phone or via text chat. Just like in-person mental health treatment, telehealth can provide sessions for individuals, families or groups. Though the details of treatment may vary, telehealth sessions are generally available for most mental health conditions.

Until recently, telehealth providers could only provide services to clients in the state in which they were licensed. Most states have loosened their regulations, allowing licensed psychologists and psychiatrists from other states to practice there. But there are still state-by-state limitations. For instance, in some states you’re allowed to do telehealth if you have a preexisting relationship with a client in that state, but you can’t start a new relationship with someone in that state.

As for payment, many insurance companies have recently begun covering telehealth treatment. In some cases, telehealth services may be reimbursed by insurance companies but not covered outright. Before starting telehealth sessions, it’s always best to check with your insurance company directly to make sure the visits will be covered and you won’t incur any unexpected expenses. Some providers might also offer sliding scale payment options for telehealth sessions.

Finally, providers offering telehealth services must follow all the usual regulations for practicing under their license. This means that they must follow HIPAA guidelines and use secure connections for online sessions. However, it is always worth checking in with them to see what cybersecurity measures they have in place to keep your sessions confidential.

Though it might seem strange at first, remote mental health treatment can actually have some advantages over in-person sessions. For instance:

• Flexibility: Without travel time and location to worry about, it can be easier for you and your child to schedule sessions at times that work well for you. What’s more, you’re not limited to seeing only professionals in your immediate geographic area, which can be especially helpful if you’re looking to work with a specialist.
• Comfort: Kids might be more willing to open up when they can talk to a therapist from the comfort of their own home, rather than an unfamiliar office.
• Direct support: Depending on what kind of treatment you’re looking for, it might be helpful to schedule sessions around specific activities that your child struggles with. For instance, telehealth enables eating disorder specialists to offer direct support at mealtimes.

That said, there can still be drawbacks to telehealth sessions. These might include:

• Body language: Video chat can replicate some of the sense of connection that comes from body language, but it’s usually not quite the same. Dr. Stern notes that with videoconferencing, providers and clients are still able to pick up tone of voice and facial expressions, but that “you don’t get as much of the full body language.”
• Lack of privacy: It may be hard to find a quiet, private space at home for your child to meet with a provider. Plus, electronics, toys and other distractions might make it harder for your child to focus on the session.
• Tech issues: As with any online platform, telehealth sessions can have their share of tech challenges. You might find yourself coping with audio glitches or slow video, which can make the session less productive.

With a little preparation, you can help your child get as much out of telehealth as they did out of in-person sessions. Here are a few tips to keep in mind:

• Let your child know what to expect. Before beginning, have a conversation with your child about what remote care is and ask if they have any questions or concerns. You can also let your child know that it may feel strange at first, but that within a few sessions it should feel at least somewhat like normal. “One way to get over the initial awkwardness is to just keep going,” advises Dr. Stern.
• Set clear boundaries. If you are usually present during your child’s appointment, then you can be there virtually as well. But if your child usually sees their provider solo, then it’s important to give them that same level of privacy now. Provide a private room if you can, and make sure that siblings and other family members don’t interrupt. This can be tricky if you are confined to a small apartment, but do your best to find fixes. For instance, if your child needs to have a session in a shared space, have the other people present put on headphones and focus on another activity.
• Do a trial run. Before the first session, Dr. Stern urges clients to make sure they can use the designated platform on the device they intend to use. Download the software if necessary and test it out ahead of time if possible. This way you won’t waste precious minutes dealing with technical difficulties.
• Know the ground rules. Your child’s provider will likely use part of the first session to set guidelines for how remote care will work, and it will probably make sense for you to be present for that conversation. If it’s a group session, then the provider should lead a conversation about rules around things like taking screenshots and sharing what others have said.
• Stay focused. Stern says it’s important to approach telehealth the same way you would in-person care. “Anything you wouldn’t do in a doctor’s office, you wouldn’t do over telehealth,” she says. That means kids should avoid things like eating a meal or scrolling through social media during their appointments, and you can help by removing distractions and making sure notifications are muted. Along the same lines, make sure your child knows that they’re expected to start on time and stay for the whole session.
• Provide support. Even if your child is meeting with their provider on their own, they will still need a hand from you at times. In some kinds of therapy, like cognitive behavioral therapy (CBT), completing homework (like diary entries or mental exercises) is crucial. Make sure you know what your child is expected to do between sessions and, if necessary, make a plan with them to figure out when and how they’ll do it. You can also check in with both your child and their provider regularly to see how the remote sessions are going. Remember that you can adapt the sessions if need be — for instance, if your child has trouble focusing at home, you could be present for part of the session to guide them or perhaps switch to shorter sessions.