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Clinical Update: Telepsychiatry With Children and Adolescents

https://doi.org/10.1016/j.jaac.2017.07.008Get rights and content

This Clinical Update reviews the use of telepsychiatry to deliver psychiatric, mental health, and care coordination services to children and adolescents across settings as direct service and in collaboration with primary care providers or other clinicians. The update defines terms and presents the current status of telepsychiatry as a mode of health service delivery. The update presents procedures for conducting telepsychiatry services and optimizing the clinical experience.

Section snippets

Methodology

A medical librarian conducted a systematic review of the literature in April 2016 and updated the search through March 2017. Searches were performed in the following databases—on the Ovid platform: Medline, PsycInfo, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials; elsewhere: Embase, Web of Science, and the National Guideline Clearinghouse. Retrieval was limited to publication dates from January 2004 to March 2017, in the English language, and on

Definitions

There is no clear definition of telehealth-related activities, and some agencies do not distinguish telehealth from telemedicine.72, 73, 74 In this Clinical Update, we adhere to definitions from the Centers for Medicare and Medicaid Services (CMS). CMS defines telehealth as the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance.75 The term telehealth describes a broad

Historical Review

As early as the 1920s, the potential for electronic media to influence people’s health and health care was recognized with the launch of “The Radio Doctor.”84 Telephony added the ability for interactive, real-time, and personalized health care interactions between a physician and a patient. The first use of interactive video to deliver health care occurred at the University of Nebraska in 1959, when a closed-circuit television system was used for educational and medical purposes, mainly in

Legal Issues

The legal and regulatory process in medical practice is dynamic in response to scientific progress, medical research, new products and procedures, best practices per medical disciplines, and stakeholders’ interests. Accordingly, state and federal agencies have started to scrutinize telepractice, largely in response to the epidemic of opioid drug abuse.102 State regulations vary, are in flux, and might not be fully congruent with federal guidelines. Additional regulations might apply to

Clinical Update Limitations

The AACAP Clinical Updates are developed to assist psychiatrists in decision making. The information in this update is not intended to define the standard of care or guarantee successful treatment of individual patients, nor should the information be deemed inclusive of all proper methods of care or exclusive of other methods of care directed at obtaining the desired results. This Clinical Update does not usurp sound clinical judgment. The ultimate judgment regarding the care of a particular

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    The Clinical Update series is discussed in an editorial by Drs. Heather J. Walter and Oscar G. Bukstein on page 811.

    This article can be used to obtain continuing medical education (CME) at www.jaacap.org.

    This Clinical Update was developed by the AACAP Telepsychiatry Committee (TPC): Kathleen Myers, MD, MPH, MS, and David Pruitt, MD, Co-Chairs, and Ruby Agoha, MD, Daniel Alicata, MD, PhD, Patricio Fischman, MD, Nicole Gloff, MD, Dehra Glueck, MD, Felissa Goldstein, MD, Pamela Hoffman, MD, Daniel Lieberman, MD, Jennifer McWilliams, MD, MHCDS, Ujjwal Ramtekkar, MD, MPE, MBA, David Roth, MD, and Lloyda Williamson, MD; additional contributors Sharon Cain, MD, and Kristopher Kaliebe, MD; and the AACAP Committee on Quality Issues (CQI): Carol Rockhill, MD, PhD, MPH, Christopher Bellonci, MD, John Hamilton, MD, Munya Hayek, MD, Helene Keable, MD, Matthew Siegel, MD, Saundra Stock, MD, and Co-Chairs Oscar G. Bukstein, MD, MPH, and Heather J. Walter, MD, MPH.

    AACAP Clinical Updates are developed by AACAP committees under the direction of the AACAP CQI, with review by representatives of multiple constituent groups including topic experts, AACAP members, other relevant AACAP committees, the AACAP Assembly of Regional Organizations, and the AACAP Council. Final approval for publishing Clinical Updates as an AACAP Official Action is conferred by the AACAP Council. The development process for Clinical Updates is described on the AACAP website (www.aacap.org).

    The primary intended audience for AACAP Clinical Updates is child and adolescent psychiatrists; however, the information presented also could be useful for other medical or behavioral health clinicians.

    Jennifer Medicus, Stephanie Demian, Karen Ferguson, Bryan Shuy, and Emily Rohlffs served as the AACAP staff liaisons for the TPC and the CQI.

    This Clinical Update was reviewed by AACAP members from September 2016 to October 2016.

    From February 2017 to April 2017, this Clinical Update was reviewed by a consensus group convened by the CQI. Consensus group members and their constituent groups were Heather J. Walter, MD, MPH, Oscar G. Bukstein, MD, MPH, Carol Rockhill, MD, PhD, MPH, and Munya Hayek, MD (CQI); L. Lee Carlisle, MD (topic expert); D. Richard Martini, MD, Committee on Collaboration With Medical Professions, and Benjamin Shain, MD, Committee on Healthcare Access and Economics (AACAP committees); Vera Feuer, MD, and Kai-ping Wang, MD (Assembly of Regional Organizations); and Karen Pierce, MD, and Lan Chi Vo, MD (AACAP Council).

    This Clinical Update was approved by the AACAP Council on May 18, 2017.

    This Clinical Update is available at www.aacap.org.

    Disclosures: During preparation of this Clinical Update, Kathleen Myers, MD, MPH, MS, and David Pruitt, MD, TPC Co-Chairs, and Heather J. Walter, MD, MPH, CQI Co-Chair, have had no financial relationships to disclose. Oscar G. Bukstein, MD, MPH, CQI Co-Chair, has had intellectual property with Routledge Press.

    Correspondence to the AACAP Communications Department, 3615 Wisconsin Avenue, NW, Washington, DC 20016.

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