Abstract
BackgroundChildren and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities.ObjectiveThe objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services.MethodsWe developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program.ResultsDuring the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions.ConclusionsThe telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation.
Highlights
About half of the children and adolescents living under the supervision of child protective services (CPS) in high-income countries have mental disorders [1]
We developed a telepsychiatry consultation program for two rural primary health care (PHC) clinics located in central Chile (Valparaíso Region) and evaluated its implementation using a mixed methods study design
We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program
Summary
About half of the children and adolescents living under the supervision of child protective services (CPS) in high-income countries have mental disorders [1]. In Chile—a Latin American developing country—69% of the population living under CPS has mental disorders and complex psychosocial care needs, but the availability and uneven distribution of specialized mental health care (SMHC) in Chile limit the provision and quality of mental health care for this vulnerable population [2,3,4]. In Chile [12] and other countries [13,14,15], child and adolescent telepsychiatry services have shown promising results for the treatment of mental disorders in PHC These initiatives have received positive feedback from health care providers serving CPS populations and reported increased use of outpatient resources for children with complex mental health care needs [16,17].
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