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Felissa Goldstein. 1 Department of Child and Adolescent Psychiatry, Marcus Autism Center, Atlanta, Georgia.
Dehra Glueck. 2 Office of Medical Student Education, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Address correspondence to: Felissa Goldstein, MD, FAPA, Marcus Autism Center, 1920 Briarcliff Road, Atlanta, GA 30329, E-mail: [email protected]
Introduction
JD was a5-year-old male, who came with his mother to their local hospital for a psychiatric evaluation with a telepsychiatrist. After several years of concerns about his behavior, they had been unable to find a qualified mental health provider in their community, and elected to seek an evaluation via videoconferencing. When they arrived at the evaluation center, the psychiatrist connected to the site through videoconferencing, was introduced to the child and his caregivers and began the evaluation. Similar to a face-to-face encounter, the psychiatrist obtained a detailed history while observing the child. JD was seen to roam the office, ignoring both the telepsychiatrist and others in the room and holding tightly to a flashlight. With these observations and the caregiver's description of restricted interests including the flashlights, limited social skills, self-injurious behaviors, and poor language development, a detailed understanding of the child was collaboratively developed. After completing a thorough diagnostic assessment, JD was diagnosed with autism spectrum disorder and was referred to appropriate interventions. JD's mother indicated that this was the first time that she had been able to share her story and receive the help she needed.
Prior to the advent of telemental health (TMH), JD might never have been evaluated. The family lives in a small town 4 hours away from the nearest tertiary care center. Limited resources, long travel times, high travel expenses, unreliable transportation, and provider shortages previously rendered this family unable to see a child and adolescent psychiatrist and, therefore, unable to pursue a diagnosis and treatment.
JD is a composite example of one of the nation's 7-20% of children with a psychiatric disorder who need a mental health evaluation. However, most of these children never receive any mental health evaluation or treatment because of the chronic shortage of child mental health specialists, particularly child and adolescent psychiatrists (Thomas and Holzer 2006) and the lack of empirically supported mental health treatments available beyond major metropolitan centers (American...