Of all of the medical specialties, child and adolescent psychiatry has the most severe shortage of practitioners. This shortage is even more pronounced in economically disadvantaged and rural areas (Clark et al., 1999; Pollitt, 2000; Satcher, 1999). The American Indian population is younger, more economically disadvantaged, and more rural than the general U.S. population (United States Census Bureau, 2000). Researchers and many American Indians believe that their traumatic history and current marginalization has made them more likely to experience mental health problems such as alcoholism and posttraumatic stress disorder (Beals et al., 2003, 2005; Spicer et al., 2003). The Surgeon General has made it a priority to improve mental health services, especially for children and adolescents (Satcher, 1999). American Indians should not be left out of this movement. Telepsychiatry, the use of real-time, interactive videoconferencing to deliver psychiatric services, is an exciting opportunity to ensure that they are not. There have been approximately 30 articles and papers regarding the use of telepsychiatry services to provide mental health services to children and adolescents (Pesamaa et al., 2004). This includes two randomized, controlled trials. One of these trials showed that diagnoses and treatment recommendations made by child psychiatrists by telemedicine and in faceto-face interviews were similar 96% of the time (Elford et al., 2000). The other showed that psychotherapeutic treatment of depressed children via telemedicine can be effective (Nelson, et al., 2003). The remaining studies are primarily descriptive and offer case examples or case series. These articles report that patients and providers were satisfied with the services offered and results obtained (Blackmon et al., 1997; Elford et al., 2000; Ermer, 1999a,b; Hilty et al., 2000; Miller et al., 2002). Although some clinicians expressed concern that it was more difficult for patients to convey emotions to providers via telepsychiatry, they concluded that their ability to provide effective, high-quality services was not significantly impaired by this. Furthermore, some clinicians have observed that the distance from the provider seemed to make it easier for some patients to relate sensitive information that could be important in treatment. The authors of these articles concluded that use of telepsychiatry can assist in providing child and adolescent psychiatric services to patients in remote and underserved areas while sparing patients and providers long, expensive, and life-disrupting journeys. One can expect that American Indians, a group that has been subjected to considerable trauma by the U.S. government, may be suspicious of initiatives by the government to try to help them. In fact, many American Indians have expressed distrust of the Indian Health Service (IHS) precisely because most of the providers are not Indian, come from outside communities, and often stay at their posts only long enough to complete their several-year commitments (Allen et al., 2004; Novins et al., 2004). Many American Indians have participated in research projects but have not Accepted September 1, 2005. Drs. Savin and Garry are with the Department of Psychiatry, University of Colorado Health Sciences Center, Denver; Dr. Garry and Ms. Zuccaro are with Rapid City Indian Health Service Hospital, Rapid City, SD; Dr. Novins is with the Division of American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado Health Sciences Center, Denver. This project was supported by grants from the National Center for Minority Health and Health Disparities (MD000507, Spero Manson, Ph.D., PI) and the Agency for Healthcare Research and Quality (HS10854, Spero Manson, Ph.D., PI). Correspondence to Dr. Daniel Savin, Department of Psychiatry, University of Colorado Health Sciences Center, University North Pavilion, Box A011-15, 4455 East 12th Avenue, Denver, CO 80220; e-mail: daniel.savin@uchsc.edu. 0890-8567/06/4504Y0484 2006 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000198594.68820.59 C L I N I C A L P E R S P E C T I V E S Associate Editor: Michael S. Jellinek, M.D.
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