Bringing Mental Healthcare to Underserved Communities
Many families drive for hours to see Dr. Kathleen Myers in her Seattle clinic, where she treats children for attention-deficit hyperactivity disorder, depression, bipolar disorder and other complex mental health problems. Those families have little choice – specialized psychiatric care is hard to find outside of major urban areas, especially for children. But Myers is never sure those families will come back and, for every family who treks to Seattle, many more can’t make the trip.
That is why Myers has spent the past two decades investigating how telemental health – mental health treatment delivered interactively, in real time via videoconferencing – can improve the lives of children in underserved communities. Her current clinical trial is examining whether telemental health care for children with attention-deficit hyperactivity disorder (ADHD) brings added value to usual care provided in children’s home communities.
“Past research has mainly looked at whether telepsychiatry is practical, feasible and acceptable to families” says Myers, a principal investigator in the Center for Child Health, Behavior and Development. “This is the first study to test whether it is effective for children.”
The study, called the Children’s ADHD Telemental Health Treatment Study (CATTS), enrolled children 5½ to 12 years old in seven underserved communities, including Seattle Children’s satellite clinics in Olympia, Wenatchee, Longview and the Tri-Cities. The participants received six videoconferencing sessions with a child and adolescent telepsychiatrist who prescribed ADHD medication and provided psychoeducation on the biological causes of ADHD.
Myers notes that “early challenges related to getting parents to trust the telepsychiatrist including accepting a prescription from someone they have never met in person. Now, parents request such services in order to obtain the help their children need.”
In the CATTS clinical trial, participating families also received six in-person sessions with a therapist in their area, who taught the parents skills in managing their children’s ADHD behaviors. These therapists were trained and supervised remotely by a psychologist at the Center for Child Health, Behavior and Development and worked remotely with the telepsychiatrists whom they never met in person.
In assessments conducted during the CATTS trial, parents reported that their children’s attention improved, that they were less aggressive and hyperactive and that they performed better in school than a control group that received treatment from their primary care providers. These results indicate that telepsychiatry is effective in helping children with ADHD who live in distant, underserved communities and may help to prevent long-term consequences of ADHD, such as the risk of drug abuse and school failure.
Myers hopes that this research is a step toward future studies to establish the effectiveness of telemental health in treating other mental health problems of childhood and adolescence. This could persuade more clinicians to embrace telemental health and encourage the Washington state legislature to mandate that insurance companies include telemental health in their benefit packages for our state’s children.
“Technological improvements are making telemental health affordable and accessible in multiple settings on a variety of personal devices. With enactment of the Affordable Care Act (ACA), another million children and adolescents are expected to become eligible for services. Stakeholders increasingly recognize that telemental health addresses the ACA’s mandate for patient-focused care and they are requesting telemental health care for their communities,” Myers says. She envisions a future in which telemental healthcare moves from the clinic to patients’ homes and other naturalistic settings, such as schools, to fully realize the promise of patient-centered mental healthcare for all children.
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