Delivery of Child and Adolescent Psychiatry Services Through Telepsychiatry

Approved by Council June, 2017

The American Academy of Child and Adolescent Psychiatry (AACAP) is a professional organization dedicated to representing the welfare and mental health needs of children and adolescents. AACAP recognizes that due to health care reform, more youth have become eligible for mental health services.1 However, the ratio of eligible youth to available child and adolescent psychiatrists, as well as other child-trained therapists, continues to increase2 and most states experience severe shortages of child and adolescent psychiatrists.3 This gap between the demand for mental health services and the supply of qualified providers is projected to increase into the foreseeable future.4 Youth with mental health conditions will be unable to obtain needed evidence-based mental health services, raising their risk of poor outcomes such as suicidality, violence, and school failure. While youth living in small towns and rural areas are the most underserved, there is growing concern for youth living in urban and suburban areas. New models of care and service delivery are needed to meet the needs of the nation’s youth.

Telemedicine refers to the use of interactive, real-time videoconferencing to deliver health care that is usually delivered in person.5 When that care involves psychiatric, mental health, or behavioral health services, the term telepsychiatry is commonly used. Telepsychiatry is not a new treatment but a venue for the delivery of evidence-based psychiatric care. It has the potential to increase access to quality mental health services in at least three major ways. First, it allows psychiatrists to deliver care directly to youth and their families over geographic distance and settings.6 Second, it improves the quality of care by disseminating psychiatric expertise for specific disorders.7 Third, telepsychiatry offers collaboration with primary care physicians8 to support their skills in providing mental health care, particularly in evolving integrated care models such as the pediatric medical home.9

Telepsychiatry has been used with patients across diverse groups6 and in multiple settings including primary care,8 schools,10 correctional settings,11 and the home.12 An evolving evidence-base has established that telepsychiatry is feasible, acceptable, and as effective as care delivered in person.13 It may be superior to mental healthcare provided in the primary care setting for selected populations such as children with attention-deficit hyperactivity disorder14 or for children with developmental disabilities who do not tolerate the clinic setting well.15 Psychotherapy,16 behavior training,17 and pharmacotherapy18 services have all been provided successfully using telepsychiatry. The Centers for Medicare and Medicaid Services have expanded their criteria for telemedicine coverage5 and individual states are increasingly allowing and reimbursing services delivered through telemedicine.19, 20

In view of these facts, AACAP recommends that each State pass legislation allowing the delivery of psychiatric services through videoconferencing by child and adolescent psychiatrists and other physicians licensed in the state in which a patient is receiving care. AACAP further recommends that each State mandates third-party payers to reimburse telepsychiatry services on par with psychiatric services delivered in person.

  1. U.S. Department of Health and Human Services. Patient Protection and Affordable Care Act (ACA; Public Law 111-148), 2010; http://www.hhs.gov/strategic-plan/goal1.html. Retrieved February 1, 2017.
  2. Flaum, M. Telemental health as a solution to the widening gap between supply and demand for mental health services. In: Myers, K., Turvey, C.L. Telemental Health: Clinical, Technical, and Administrative Foundations for Evidence-based Practice. New York, N.Y., Elsevier, 2013, pp 11-25.
  3. American Academy of Child and Adolescent Psychiatry. Workforce Maps by State. https://www.aacap.org/aacap/Advocacy/Federal_and_State_Initiatives/Workforce_Maps/Home.aspx. Retrieved February 15, 2017.
  4. Insel, T. Where are we going? Director’s Blog: Psychiatry: National Institute of Mental Health, 2011. Available at: http://www.nimh.nih.gov/about/director/2011/psychiatry-where-are-we-going.shtml. Retrieved February 1, 2017.
  5. Center for Medicare and Medicaid. Telehealth. Retrieved from: http://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html. Accessed May 11, 2016./li>
  6. Gloff, N., Lenoue, S., Novins, D., & Myers, K. (2015). Telemental health for children and adolescents. International Review of Psychiatry, 27(6), 512-524.
  7. Fortney, J.C., Pyne, J.M., Mouden, S.B., Mittal, D., Hudson, T.J., Schroeder, G.W. et al.(2013). Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: A pragmatic randomized comparative effectiveness trial. American Journal of Psychiatry, 170, 414-425.
  8. Goldstein, F.& Myers, K. Telemental health: A new collaboration for pediatricians and child psychiatrists (2014). Pediatric Annals, 43(2), 79-84.
  9. McWilliams, J.K.(2016). Integrating telemental healthcare with the patient-centered medical home model. Journal of Child and Adolescent Psychopharmacology, 26(3), 278-282.
  10. Stephan, S., Lever, N., Bernstein, L., Edwards, S., & Pruitt, D. (2016). Telemental health in schools. Journal of Child and Adolescent Psychopharmacology, 26(3), 266-272.
  11. Bastastini, A.B. (2016). Improving rehabilitative efforts for juvenile offenders through the use of telemental healthcare. Journal of Child and Adolescent Psychopharmacology, 26(3), 273-277.
  12. Comer, J.S., Furr, J.M., Cooper-Vince, C., Madigan, R.J., Chow, C., Chan, P. et al. (2015). Rationale and considerations for the internet-based delivery of parent-child interaction therapy. Cognitive Behavavior Practice, 22(3), 302-316.
  13. Ruskin, P.E., Silver-Aylaian, M., Kling, M.A., Reed, S.A., Bradham, D.D., Hebel, J.R., et al. (2004). Treatment outcomes in depression: Comparison of remote treatment through telepsychiatrry to in-person treatment. American Journal of Psychiatry, 161, 1471-1476.
  14. Myers, K., Vander Stoep, A., Zhou, C., McCarty, C.A. & Katon, W. (2015). Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: A community-based randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 54(4), 263-274.
  15. Reese, R.M., Jamison, R,, Wendland. M,, Fleming. K,, Braun. M,J,, Schuttle,r J.O. et al. (2013). Evaluating interactive videoconferencing for assessing symptoms of autism. Telemedicine Journal and E-Health, 19(9), 671-677.
  16. Duncan, A.B., Velasquez, S.E. & Nelson, E.L. (2014). Using videoconferencing to provide psychological services to rural children and adolescents: A review and case example. Journal of Clinical Child and Adolescent Psychology, 43(1), 115-127.
  17. Comer, J.S., Furr, M.N., Cooper-Vince, C.E., Kerns, C.E., et al. (2014). Internet-delivered, family-based treatment for early-onset OCD: A preliminary case series. Journal of Clinical Child and Adolescent Psychology, 43(1), 74-87.
  18. Cain, S. & Sharp, S. (2016). Telepharmacotherapy for children and adolescents. Journal of Child and Adolescent Psychopharmacology, 26(3), 221-228.
  19. American Telemedicine Association. State telemedicine gaps analysis: Coverage & reimbursement–Parity laws for private insurance. Available at: http://www.americantelemed.org/docs/default-source/policy/ata-map-telemedicine-parity-2014-3-7.pdf. Retrieved February 1, 2017.
  20. American Telemedicine Association. State Policy Resource Center. Retrieved from: http://www.americantelemed.org/main/policy-page/state-policy-resource-center; Accessed February 15, 2017.