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Since the start of the COVID-19 pandemic, there have been rapid shifts in the utilization of technology to provide mental health care. Telemental health (TMH) involves the use of electronic communications technology to provide mental health services and supports at a distance. A variety of services can be provided via TMH including medication management, counseling, consultation, assessment, and education. TMH services can be provided on a device as simple as a smartphone, computers and more sophisticated devices such as video conferencing equipment. While technology has long been used to provide access to care in rural settings, technology is now being used in a variety of settings, including urban and suburban communities and with varied populations to improve access to high-quality mental health and psychiatric services and supports (Mayworm et al., 2020). TMH services offer a unique opportunity to overcome many common barriers to care such as transportation costs, inconvenient appointment times, and a lack of available providers.
Increased Access to Mental Health Services
TMH has been an essential strategy for allowing youth and families to continue to access mental health services and supports during the COVID-19 pandemic. With schools and outpatient mental health centers closed in many communities, finding a way to remain connected to support the mental health and well-being of youth and families has been essential. Federal and state regulation changes (e.g., loosening of privacy parameters; reimbursement for telephone communication) have allowed for a widened service array by a broader range of licensed providers (e.g., social workers, psychologists, professional counselors) through TMH. Licensed mental health clinicians and advanced graduate trainees have used telehealth to provide mental health promotion activities to improve social-emotional learning skills and positive coping strategies to all students and to provide treatment to individuals, families, and small groups in need of additional mental health support.
Providing TMH care can significantly increase access to care, as many people who participate in TMH services, would not otherwise receive those services. Providing TMH care in schools or in homes during physical distancing offers access to youth and their caregivers. TMH also enhances opportunities for multidisciplinary collaboration between providers, as multiple individuals in different locations can join a TMH session. Clients, including students and families, and providers report high satisfaction with TMH services, and data demonstrate that TMH services are just as effective as in-person services (Cunningham, Willis, Cox, et al., 2018; Mayworm et al., 2020; Richardson, Frueh, Grubaugh et al., 2009).
Range of Services That Can Be Provided via Telemental Health
Within the school setting, there are various models of TMH services utilized, ranging from consultation to direct care models (Stephan, Lever, Bernstein, Edwards, & Pruitt, 2016). In consultation models, a remote provider can provide consultation to a local provider, school staff or family members. The remote health care professional, such as a psychiatrist or licensed nurse practitioner, can provide treatment recommendations, assist with assessment and diagnosis, and provide family and school staff education. When working hand-in-hand with a school-based provider, the remote provider is offering a “collaborative care” model to augment existing school-based services. In direct care models, a remote provider is responsible for diagnosis, assessment, and treatment of the client. In other cases, some organizations utilize hybrid models that involve some combination of direct care, collaborative care, and /or consultation. The model selected will depend on a host of factors including the needs of the school, availability of providers, funding, technology, and consent for services.
Some challenges remain with providing TMH care in schools and during physical distancing, including provider and student/parent comfort and skill with utilizing the technology, poor broadband infrastructure, and limited access to adequate space to facilitate the sessions. Despite these potential limitations, TMH care is a valuable component of care that offers mental health support at a distance when it is needed, now more than ever, for students, their families, and the school staff and providers who work with them.
This blog was authored by Dana Cunningham, Nancy Lever, and Sharon Hoover from NCSSLE partner National Center for School Mental Health.
We encourage you to explore our website for further information. Here are some resources that can help districts explore telemental health services.
Cunningham, D.L., Willis, K., Cox, J., Bolan, R., Moore, S., Beason, T., & Connors, E. (2018). Scotty, Beam Me Up! (or at least to the next school): Telepsychiatry in Schools. 2018 Annual Conference on Advancing School Mental Health, Las Vegas, Nevada. Conference Presentation.
Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The Effectiveness of Telemental Health: A 2013 Review. Telemedicine Journal and E-Health, 19(6), 444–454. http://doi.org/10.1089/tmj.2013.0075
Mayworm, A. M., Lever, N., Gloff, N., Cox, J., Willis, K., & Hoover, S. A. (2020). School-based telepsychiatry in an urban setting: efficiency and satisfaction with care. Telemedicine and e-Health, 26(4), 446-454.
Richardson, L.K., Frueh, B.C., Grubaugh, A.L., Egede, L., & Elhai, J.D. (2009). Current directions in video-conferencing tele-mental health research. Clin Psychol (New York). 2009 Sep 1; 16(3): 323–338. doi: 10.1111/j.1468-2850.2009.01170.x
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.