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Pediatric mental health experts share tips to make the most of telehealth visits

January 15, 2021

Outpatient behavioral and mental health services declined dramatically for many children during the pandemic and have not rebounded, according to government data. Telehealth can be a valuable tool for pediatricians and their patients to improve access to care.

The first AAP Virtual Office Hour on mental health care for children and adolescents during the pandemic explored how pediatricians can use telehealth. The discussion was led by Cori Green, M.D., M.Sc., FAAP, a member of the AAP mental health leadership workgroup, and Christopher Bellonci, M.D., FAACAP, a child, adolescent and adult psychiatrist.

Among the benefits, telehealth eliminates transportation issues, gives more patients access to services with shorter wait times, and can reduce stigma surrounding mental health for families. Many patients find it more comfortable to discuss personal matters from home, and health care providers find it useful to see patients in their own environment.

Technology can present disadvantages, but awareness and planning can stave off problems, said Dr. Bellonci and Dr. Green. During the pandemic, schools have stepped up to provide telehealth and telesupport for students, particularly for students who are absent during remote learning. Schools also have been developing approaches toward strategic outreach such as ensuring students have technology (e.g., broadband access, a computer, etc.) to participate, Dr. Bellonci said.

At most health supervision visits, Dr. Green routinely asks an open-ended question such as, “This has been a hard time for people. How are things going for you?” She also regularly asks about changes in sleep, toileting, feeding, separation, internalizing symptoms, externalizing behaviors, and somatic symptoms. If an issue is identified, telehealth is a valuable tool for conducting a follow-up appointment, said Dr. Green, associate professor of clinical pediatrics and director of behavioral health education and integration at Weill Cornell Medicine.

Being comfortable with the technology bolsters the experience, said Dr. Bellonci, assistant professor at Harvard Medical School and vice president of policy and practice, chief medical officer at Judge Baker Children’s Center. He advised pediatricians to be aware of how they present themselves, look at the camera instead of the screen and lean in to show their interest in the conversation.

Drs. Bellonci and Green shared the following advice to help pediatricians make the most of telehealth visits for mental health:

  • When feasible, administer screening tools via the patient portal before the visit. When administering new assessments for attention-deficit/hyperactivity disorder, have a teacher who knew the child before the pandemic started, complete the assessment. Be aware that many neuropsychological evaluations and developmental batteries may be normed and validated only when administered in person.
  • Ensure families have suitable technology for telehealth. Investigate resources offered in the community, such as schools or libraries, for families without broadband access (see
  • Have parents put a tablet or smartphone on a stable surface for clear communication. Ask them to turn off the television and give a coloring book to young children to occupy them during the visit. Invite children to share something from their surroundings and allow them to talk when it is their turn.
  • Provide evidence-based behavioral health skills and coaching interventions for caregivers of younger children. Observe the child in his or her environment and have the caregiver wear earbuds to be coached through interventions.
  • Remember that the same adolescent confidentiality rules apply for telehealth as in the office. Adolescent patients can use headphones or earbuds while talking privately with you from a separate room. Remind parents that they would be asked to step out of the room for in-person visits and have a way to reach the caregiver during the visit.

Pediatricians should be prepared if serious concerns arise and know how to respond to emergencies, Dr. Bellonci said. “When you highlight issues … needing immediate attention, you obviously have a moral and ethical obligation to respond,” he said. “Do your pandemic best to identify critical, actionable sorts of items.”

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