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Telemedicine, School-Based Psychiatry programs increase access to care

Mar. 21, 2019, 10:06 AM

 

by Kelsey Herbers

Vanderbilt University Medical Center’s School-Based Psychiatry Program is now offering telemedicine services for children and families who may have barriers to accessing appointments with a practitioner through traditional clinics.

The new program, which has been piloted over the last two years and officially launched at the beginning of the 2018-2019 school year, allows children who are receiving psychotherapy from one of Vanderbilt’s 27 embedded, master’s level therapists in 33 Metro Nashville Public Schools to meet with a practitioner via video conference for questions regarding medications.

The virtual visit enables a Child and Adolescent Psychiatry fellow or nurse practitioner to “meet” with the child, therapist and family simultaneously without having to travel to the school and without requiring the family to travel to a clinic.

Cheryl Cobb, MD

“Using telemedicine reduces the amount of time providers spend driving between schools, which allows them to be more flexible in scheduling appointments,” said Cheryl Cobb, MD, medical director of Outpatient Services for Vanderbilt Behavioral Health, who also noted that practitioners would often arrive to a school for an appointment only to find the child stayed home sick.

“We really want families to be involved in these appointments, and that was difficult for them when we had such limited time intervals we could offer. Now, any day that we have available is available to every child we serve.”

Telemedicine sessions are conducted using laptops equipped with multidirectional microphones so multiple participants can speak without having to pass the computer. Since its official launch in August 2018, more than half of the program’s school-based medication visits have switched to the platform.

Vanderbilt’s School-Based Psychiatry Program aims to provide mental health services to underserved children across Davidson County. While many of the children seen by Vanderbilt therapists have experienced trauma and could benefit from psychiatric treatment, they may lack basic needs such as transportation, making it difficult for families to take them to appointments.

“If a family doesn’t have a car, how does their child get weekly psychotherapy?” said Cobb. “If the guardian is a great-grandma with her own health issues, how is she going to get the child to an appointment, and who’s going to watch the child’s siblings while she goes?”

Aside from increasing access to psychiatric services, the school-embedded therapy provides a better-informed approach to treatment.

“The therapist in the school knows which children are in trouble in the lunch room. They know which parents attend the parent-teacher conferences. When you’re in the clinic, you get a disproportionate picture — you get the parent’s perception of how their child is doing,” said Cobb.

According to Charity Ingersoll, LCSW, clinical director of Vanderbilt’s School-Based Programs, therapists can work with a child’s teacher to determine the best time of day for the child’s appointments, ensuring the least amount of impact on his or her core classes. By having appointments in the school building, children don’t have to miss class time traveling to and from a clinic, and guardians don’t have to take vacation time to pick their child up from school.

The approach can also strengthen the relationship between children and their teacher, leading to better outcomes.

“When children have a mental illness, it often presents as a behavioral issue,” said Cobb. “If you can shift the teacher’s view of that child from ‘He or she makes my life difficult’ to viewing them as a child who is hurting and doesn’t know how to express his or her feelings, everything else changes. The child won’t escalate as much because they’re treated differently. The behavior problems diminish, and the child starts to build better self-esteem.”

To participate in the School-Based Psychiatry Program, children must be referred by their parents, guardians or the school.

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