Telepsychiatry in a Child’s System of Care
William French, MD, DFAACAP

• A system of care is a spectrum of effective, coordinated community-based resources for children with or at the highest risk for mental health disorders and functional decline. Services are geared toward maintaining treatment in the community.
• Wraparound is the practice model used to implement a system of care with multiple clinical and non-clinical individuals depending on the child’s needs and resources.
• Many communities do not have child and adolescent psychiatrists to participate in the child’s wraparound team. Child and adolescent telepsychiatrists can fill this need.
• The child and adolescent telepsychiatris’s role within a wraparound team will vary based on the resources available at patient site. The psychiatrist, including telepsychiatrist, does not lead the team. Child and adolescent telepsychiatrists have to decide their comfort in working within the available resources and the wraparound team’s expectations of their role. 
• Child and adolescent telepsychiatrists have responsibilities to the wraparound team to collaborate in providing timely interventions that may help prevent children’s functional deterioration and referral to residential treatment. Telepsychiatrists may have to be flexible with their schedules.
• Child and adolescent telepsychiatrists have responsibilities to the child and family to work toward optimal treatment that addresses their strengths and weaknesses and minimizes adverse effects. Sessions should focus on the child and family’s goals.
• Organizing events in which telepsychiatrists can interact with staff and patients can demonstrate a genuine interest in and build rapport with the wraparound team and the patient. Visits to the community in person are helpful in team buiding; virtual participation is highly valued.

References

1.  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.
2.  Fortney JC, Pyne JM, Turner EE, et al. Telepsychiatry integration of mental health services into rural primary care settings. International Review of Psychiatry. 2015; 27(6): 525-539 
3. McGinty K, Klaehn R, Metz P, et al. Wraparound, system of care, and child psychiatrists. Journal of the American Academy of Child and Adolescent Psychiatry. 2013; 52(11):1124-1127
4. Stroul, B., Blau, G., & Friedman, R. Updating the system of care concept and philosophy. Washington, DC: Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children’s Mental Health. 2010.