Virtual House Calls - Increasing Access to Behavioral Healthcare for Patients and Their Families

Today, more patients and their families can access high-quality behavioral care without leaving their  homes. Driven by an increasingly tech-savvy society with an increasing need for mental-health services, the growth of behavioral telehealth helps eliminate barriers to behavioral healthcare for individuals and families.

Particularly for patients in rural and underserved communities who might otherwise need to travel for hours to visit a provider in person, telehealth promises behavioral healthcare that’s private, cost-effective, and convenient.

But telehealth isn’t just about convenience. Research shows that behavioral telehealth supports positive outcomes for patients. A systematic review published by the Agency for Healthcare Research and Quality found that telehealth is an effective treatment for psychotherapy. According to a report from the Substance Abuse and Mental Health Services Administration (SAMHSA), teletherapy can increase medication compliance, motivate patients to enter treatment, and reduce symptoms of anxiety and depression. Another study found that trauma-focused cognitive behavioral therapy could be delivered via one-on-one videoconferencing without compromising its therapeutic benefits; the study noted significant clinical improvements and high rates of satisfaction from both patients and providers.

Nearly half of behavioral-health providers use some form of telehealth, according to a 2018 study by the Behavioral Health Workforce Research Center at the University of Michigan. The researchers found that psychiatrists and counselors are the behavioral-health professionals most likely to use teletherapies.

Mark Lo quoteBut the adoption of telemedicine for behavioral health still lags behind primary care and specialty care, researchers note. That’s particularly true in pediatric behavioral healthcare, says Mark Lo, MD, MS, emergency medicine physician with Seattle Children’s Hospital. The result: too many pediatric patients and their families struggle to access effective behavioral healthcare, or spend too much time driving to far-flung appointments.

In April 2018, Dr. Lo and Sarah Orth, Seattle Children’s Hospital’s telehealth senior program manager, established the Telehealth Direct to Consumer pilot program to help bring pediatric telemedicine up to speed. The program initially served patients in the Autism Center’s Pediatric Feeding, Biobehavioral and Medication Evaluation and Management programs. It has since expanded to include the  organization’s Psychiatry and Behavioral Medicine, Neuropsychiatry, and Program to Enhance  Attention, Regulation and Learning (PEARL) clinics.

Over the program’s first nine months, participating area teams met with 119 different patients during 295 video visits, saving families some 48,465 miles of driving. 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.

“Healthcare is no longer about the solo provider,” says Lo. “A lot of these visits are multidisciplinary. You may have a mental-healthcare provider, a social worker, a dietician or athletic trainer, several different ancillary services, or an interpreter. 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, but can beam in via telehealth.”

The program yielded some surprising benefits, too. 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,” Lo 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 says. 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,” Lo notes. “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 the Puget Sound area and beyond. Just as importantly, pediatric patients can spend less time traveling to healthcare appointments, and more time just being kids. ‘’Pediatric telemedicine is coming along,” Lo says. “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.’’