Children and Telehealth in Mental Healthcare: What We Have Learned From COVID-19 and 40,000+ Sessions.
Children and Telehealth in Mental Healthcare: What We Have Learned From COVID-19 and 40,000+ Sessions.
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DOI：
10.1176/appi.prcp.20200035
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发表时间：
2021
影响因子：
--
通讯作者：
Schechter I
中科院分区：
文献类型：
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作者：
Hoffnung G;Feigenbaum E;Schechter A;Guttman D;Zemon V;Schechter I
COVID-19对当代医疗保健的诸多影响之一是向远程医疗（TH）服务的快速和压倒性转变。TH对治疗的确切影响尚不清楚，可能的儿童/成人差异是TH服务的效用和改善这些服务的努力的一个重要澄清点。目前的研究考虑了反映2020年前六个月COVID-19封锁前、封锁期间和封锁后的数据。数据包括在纽约州罗克兰县的一家认证社区精神卫生诊所（CCBHC）的多个门诊精神卫生站点向N = 2520名独立客户提供的N = 43，294项服务的记录，该地区是COVID-19的重灾区。结果显示，儿童与成人的服务时段有显著差异，儿童精神健康服务的数目在2020年3月转为TH（开始封锁）后相对减少，而当面对面服务于2020年5月及6月恢复时，儿童服务相对迅速地恢复面对面服务。结果进一步突出了儿童年龄和服务类型之间的显着差异，与精神病学TH比心理治疗的影响较小。数据中隐含的是远程提供大量持续行为干预的能力。研究结果支持TH为儿童不如成人的首选，同时表明，儿童TH是精神病学和支持服务的青睐，心理治疗少。提高儿童TH交付和继续研究的方向的影响包括关系因素，平台（电话/视频）和屏幕显着性。尽管发生了大流行病，但迅速转向远程保健成功地维持了成人和儿童门诊的大量精神保健服务。儿童和成人之间存在显着差异，在使用远程医疗服务利用率的一个强大的数据记录证明。服务类型的问题，远程健康与困难表现在儿童心理治疗，但不是在儿童精神病学和支持服务。必须加强通过远程保健对儿童的心理治疗，以优化影响;突出性、注意力和疲劳可能是成功实施的重要因素。
Of the many impacts of COVID‐19 on contemporary healthcare is the rapid and overwhelming shift to remote telehealth (TH) service. The precise effect of TH on treatment is yet unknown, and the possible child/adult differences are an essential point of clarification for the utility of TH services and efforts to improve upon them. The current study considers data reflecting pre‐, during‐, and post‐COVID‐19 lockdown over the first six months of 2020. Data comprise records of N = 43,294 services delivered to N = 2520 unique clients across multiple outpatient mental health sites at a Certified Community Based Mental Health Clinic (CCBHC) in Rockland County, NY, an area hard hit by COVID‐19. Results demonstrate significant differences between child and adult sessions with a relative decrease in the number of child mental health services with the switch to TH in March 2020 (onset of lockdown) and a relatively rapid shift back to face‐to‐face among child services when in‐person services resumed in May and June 2020. Results further highlight significant differences between child age and service type, with psychiatry less affected by TH than psychotherapy. Implicit in the data is the ability to offer remotely, a high volume of ongoing behavioral intervention. Findings support TH as less preferred for children than adults while indicating that child TH is favored for psychiatry and support services, less so for psychotherapy. Implications for enhancing child TH delivery and directions for continued research include relational factors, platform (phone/video) and screen salience. Rapid shift to telehealth was successful in maintaining a high volume of mental health services for both adult and children outpatient services despite pandemic. Significant differences exist between children and adults in the use of telemental healthcare as demonstrated in a robust data record of service utilization. Service type matters in telemental health with difficulty demonstrated in child psychotherapy, but not in child psychiatry and support services. Psychotherapy for children via telehealth must be enhanced to optimize impact; salience, attention and fatigue, may be important factors to be addressed for successful implementation.