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Telepsychiatry with Children and Adolescents in Community Mental Health Settings
Lynda Lee Carlisle, MD, DFAACAP
Federal mandates that have increased the eligibility of children and adolescents for mental health care have not comparably increased the capacity for services.
In non-metropolitan communities, youth often receive their mental health care at community mental health centers. Child and adolescent telepsychiatrists can provide the psychiatric services that are not available locally.
There is often a wide variety of staff specialists at community mental health centers, and they may not be child-trained. Many are not yet licensed, or are working toward advanced degrees. Child and adolescent telepsychiatrists may play an important collaborative role to upgrade evidence-based, child-specific services and bolster support networks.
Psychiatrists providing telepsychiatry to rural areas can help to build capacity and bridge the access-to-care gap by referring youth back to their primary care provider for medication management after evaluation and/or stabilization. This collaboration can open telepsychiatrists’ schedules more quickly to increase access and provide a resource for primary care providers.
Staff and administrators at community mental health centers may need some education to learn how to work remotely with psychiatry, to appreciate its benefits, and to overcome limitations.
Child and adolescent telepsychiatrists must learn how to work within the structure and resources available in under-resourced community mental health centers in distant communities.
Bruns E, Suter J. Summary of the Wraparound Evidence Base: April 2010. In: Resource Guide to Wraparound. National Wraparound Initiative, Portland, OR (2011). Theory and Research: Chapter 3.5.
Kriechman A, Bonham C. Telemental health in primary care. In: Telemental Health: Clinical, Technical, and Administrative Foundations for Evidence-based Practice. Eds: Myers K and Turvey C. Elsevier Insights. Waltham, 2013;
U.S. Department of Health and Human Services. Patient Protection and Affordable Care Act (ACA); Public Law 111-148; 2010. https://www.govinfo.gov/content/pkg/STATUTE-124/pdf/STATUTE-124-Pg119.pdf
Thomas K, Ellis A, Konrad T, Holzer C, Morrissey J: County-level estimates of mental health professional shortage in the united states. Psychiatric Services 60:1323-1328, 2009.
The Muskie School of Public Service. The Role of Community Mental Health Centers as Rural Safety Net Providers Working Paper #30 November 2002; https://muskie.usm.maine.edu/Publications/rural/wp30.pdf Accessed July 1, 2018.