Like adult telepsychiatry, child telepsychiatry can be implemented using a variety of models that range from traditional behavioral health outpatient models to integrated primary care models. Some of those models are described in Chapter 10. Other common child-specific models include school-based and juvenile justice–based telepsychiatry.
School-based models are gaining increasing attention as a way to increase mental health access to youth, particularly those unlikely to access mental health services otherwise, reduce the stigma associated with mental health treatment, provide opportunities for mental health promotion and not just treatment, and substantially increase typical rates of care plan follow-up. 12 Given the shortage of child and adolescent psychiatrists, many school-based models incorporate the psychiatrist as a consultant for medication management support into a multidisciplinary treatment team that may include parents, teachers, nurses, occupational therapists, and school-based mental health professionals such as school psychologists. School-based health clinics are a natural fit for telepsychiatry as they establish primary and integrated care settings within the school. Less frequently, psychiatrists provide direct, virtual patient care in the school setting. In instances of direct patient care, the virtual modality decreases the need for travel for both the psychiatrist and the patient and limits missed appointments as patients are already in the school setting. 12
Although more research is still needed, school-based telepsychiatry appears an effective and acceptable model. Both consultative and direct care applications have advantages for patients and families such as reduced scheduling demands, the opportunity for parents to participate in virtual sessions from their own work or homes, the support and engagement in school personnel in implementing and monitoring the patients’ progress on the care plan, and the potential increase in comfort level for parents who already trust the school's personnel.
A disadvantage for some patients/families is the reduced privacy that comes from having a multidisciplinary school team involved in student mental health care. Other disadvantages from the psychiatric provider perspective include the potential for limited parent engagement in the care plan and the additional challenge presented by practicing psychiatry not just virtually, but within the unfamiliar culture of a school and a multidisciplinary school team. Some providers have recommended a hybrid model of in-person and virtual care for the most effective, culturally competent school-based telepsychiatry. 12
Juvenile justice populations have particularly high rates of psychopathology, barriers to care access, and particularly high care costs. As such, juvenile justice–based telepsychiatry models are increasingly being implemented in settings from community-based probation to secure commitment facilities to increase care access and decrease costs. 13 Similar to school-based models, juvenile justice–based models typically require the psychiatrist to work with a team of professionals and not just the parent and child, as in a typical outpatient application. In addition, juvenile justice settings must maintain a safety and security priority—which may affect the traditional patient–provider alliance and privacy assurances, as well as the ability of patients, parents, and/or correctional staff to implement care plans as designed. Other challenges may include treatment-resistant youth and/or parents/staff and particular difficulty accessing patient medical histories. Overall, however, there is growing evidence of feasibility across juvenile justice settings, and psychiatrists willing to work within the challenging environment have an opportunity to work at the top of their clinical scope and affect a population in severe need. 13,14