5.3.3  Working with children and adolescents
Delivering telepsychology to a vulnerable population, such as children and adolescents, presented our team with a unique set of challenges, which compelled our pediatric behavioral health team to make a number of operational changes, adapting to the shifting service delivery landscape at our medical center. Our first steps in pediatrics were to check in with our medical team partners, to familiarize ourselves the new policies around pediatric well and sick visits, and to obtain their feedback on our tentative plan for telepsychology deployment. Generally, our plan was to offer telepsychology to families referred to us via their pediatrician, with an emphasis on prioritizing those presenting problems that have been a good fit for our behavioral health services thus far: adolescents and young adults with internalizing concerns (i.e., depression, anxiety) and children with home behavioral concerns. We hypothesized (and subsequently confirmed) that many of our patients' caregivers who had school‐related concerns would choose to pause their sessions with us, given the current school closures. For the time being, warm hand‐offs would be suspended as well. After conferring, our primary care psychology supervisors and medical team leaders (i.e., directors of the primary care clinics, nursing, and patient services) approved of the telepsychology plan to continue the provision of behavioral health services to pediatric patients and that we would check in regularly to discuss ongoing clinic needs and any feedback about the new pediatric primary care telepsychology services.
With the plan in place, we began to start the roll‐out of telepsychology services. Once their telepsychology training (detailed above) was complete, our graduate student therapists began calling all patients and their caregivers on our schedule for the upcoming week to inform them that we were moving to a telepsychology model of care during the pandemic and to gauge their interest in continuing care under this model. Many families were glad to hear from our team, but felt that behavioral health services for their child was no longer their top priority. Approximately half of our current patient load decided to continue care with us via telepsychology. Using a structured consent form, our team obtained and documented verbal informed consent to treat via telepsychology with these families. Thus, our pediatric primary care psychology team delivered telepsychology services to many of our teens with depression and/or anxiety, which for some, was exacerbated by the COVID‐19 pandemic and the social distancing and stay‐at‐home orders in our locale. Given the increased amount of time that caregivers and children were spending together due to school closings, many caregivers felt stressed and in need of stress management techniques and/or behavioral parent training. Our team also provided those therapeutic strategies via telepsychology. Additionally, while we had a very structured crisis management plan in place for any acute issues (e.g., suicidality), we have not yet had to use it. Communication with our medical colleagues went very well. We had some initial worries about not being colocated in the clinics during this time and losing some of the face‐to‐face time that had seemed vital to maintaining our presence as team members. However, communication via secure email as well as the electronic medical records were seamless as we all worked toward the common goal of providing good family‐centered care.
Despite our successes, there were some barriers to serving our pediatric families via telepsychology. For instance, as with our adult clinics, our patient load decreased, as many referrals were for school‐based concerns. Additionally, we were no longer obtaining referrals via warm hand‐offs. Also, there may have been some families who had other significant concerns (e.g., paying rent, losing their job, taking care of an ill family member). Given that our patient population is from the communities being hardest hit by COVID‐19 (i.e., low‐income, predominantly Black/African American families), it is no surprise to us that child behavioral health concerns were not at the top of the list of priorities for families.
Providing evidence‐based services via telepsychology through our pediatric clinics presented another challenge. It was difficult to have telepsychology sessions with caregivers who had young children, as those children were often in the room, making noise, needing their caregivers' attention. In clinic, we were able to have a graduate student therapist assist with childcare; that is not possible with telepsychology. Therefore, we are still navigating the best ways to provide telepsychology to parents who have more chaotic home environments (e.g., scheduling an appointment during a child's naptime).