Psychiatr News March 2, 2007
Volume 42, Number 5, page 22
© 2007 American Psychiatric Association
Telepsychiatry Gets Good Reception With Texas High School Students
Barbara Bryant
Telepsychiatry can improve access to mental health care for students and
hard-to-reach and underserved populations. It can also be used as a tool to
train medical and mental health care professionals.
Christopher Thomas, M.D., is using state-of-the-art videoconferencing
facilities to provide psychiatric services to students at Ball High School in
Galveston from his office at the University of Texas Medical Branch at
Galveston (UTMB).
Funded by a $500,000 grant from the Robert Wood Johnson Foundation and
matching grants from six Galveston and Houston foundations, UTMB began the
project last summer, setting up a video-conferencing work station at a
nonprofit, primary care clinic at Ball High School.
Thomas and students see and speak to each other through flat-panel
televisions and related equipment in both the school and his office. The
funding will also allow the university to install these stations in clinics at
three Galveston middle schools.
"The thing I am most excited about with this program is the
opportunity to provide better access to mental health services to
youth," Thomas, a professor of psychiatry and behavioral sciences at
UTMB, told Psychiatric News. He believes this approach can do much to
help address the shortage of child and adolescent psychiatrists, particularly
in rural and impoverished areas, and to make these services more accessible to
many others who need them.
The program allows students to remain at school to receive counseling
services and allows parents to participate there as well, which many prefer to
having to pick up their children at school and taken them to a doctor's office
or clinic.
Thomas also noted that other students may be less likely to notice when
their peers are receiving such services if they're provided on site rather
than forcing children to leave school premises, thus increasing privacy and
reducing potential stigma. In addition, providing these services at school
makes it less likely that referrals for treatment will "fall between the
cracks" as often happens after a child is sent from school to another
location for psychiatric evaluation.
Thomas said the youngsters he has dealt with are often more receptive to
the teleconferencing approach than are some physicians who are not used to
dealing with patients remotely. "Many of the children are fascinated to
see themselves on the monitor," he said. "It's a good opportunity
to have them talk about themselves and tell me what they see."
Thomas also believes that telemedicine can increase access to young
patients in nonschool settings. He envisions using it to reach youth in
detention or correctional facilities and said he would like to see
telepsychiatry integrated with primary care by making it available through
community health clinics and pediatric practices.
Thomas has already used the technology to conduct in-service sessions for
teachers and counselors who dealt with students who were affected by
hurricanes Katrina and Rita and began in 1999 to provide psychiatric services
for victims of domestic violence that involved school outreach and community
education. He said he has found the approach to be quite helpful in serving
this population.
"Research indicated that victims of violence have difficulty forming
a therapeutic relationship with therapists of the same sex as their
abusers," he explained. "I now think that the use of
teleconference facilitated my forming a therapeutic alliance with the
patients, as it formed a clear physical separation."
The University of Texas Health Science Center in Houston has also used
telemedicine to provide pediatric and specialty consultation through school
nurses in the Rio Grande Valley.
Telepsychiatry does pose some logistical limitations, he noted. "I
cannot physically interact in the play assessment or play therapy, but I can
still have a child talk about their play and use the presenter [an adult who
is present during at least part of many sessions to help make appointments and
escort or otherwise assist children and parents during sessions] or have the
child pretend to take my role in the play, which can be very revealing,"
he said.
In addition, technical glitches sometimes arise that can hinder access,
Thomas noted, due to interference caused by computer firewalls or other
programming issues. He once wound up conducting sessions by telephone, rather
than on screen after a backhoe cut through his office's dedicated T1
communications line. He said that his young patients were quite disappointed
that they couldn't appear that day "on television."
Thomas said that planning for the provision of telemedicine services must
involve detailing all aspects of the service delivery system, especially when
multiple agencies are involved. "The protocol makes clear the sequence
of events in providing services and everyone's role in delivering them,"
he explained. "Regular review of service delivery is also important, and
the protocol provides a framework to carry out quality assurance."
More information about UTMB's use of telemedicine is posted at
<www.utmb.edu/telehealth>.
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