Telehealth Services for Children and Youth: 7 Tips for Clinicians

As more providers have made the transition to telehealth during the coronavirus pandemic, clinicians and organizations who work with children and youth have also needed to quickly learn how to implement telehealth for their young clients. This transition can seem daunting, but it is entirely possible to treat children effectively via telehealth. In fact, telehealth can offer advantages for children and youth who may not enjoy or benefit from a traditional office session, as being at home in a comfortable environment can help ease anxiety and self-consciousness.

The American Telemedicine Association has created practice guidelines to assist clinicians providing behavioral health services to children and adolescents via telehealth. Here are 7 tips to help you create the best online environment for the children and youth you serve:

1. Properly introduce children and caregivers to telehealth

For children and families who have not used telehealth before, it’s critical to clearly explain to them what the telehealth session will be like and how to successfully access the telehealth technology. For very young children, it can be beneficial to compare it to common technology they may have used before (such as FaceTime or Skype). For some older youth, they may need reassurance that the session is private and not “on the Internet”, so take time to discuss the confidentiality of the platform you are using.

2. Manage expectations

Using telehealth technology comes with its own unique challenges, so make sure to set clear expectations with your clients. Discuss what to do if any technological issues arise, and accept these challenges with grace and humor when they do happen. Also make sure to manage your own expectations. Recognize that it can be difficult, especially for very young children, to stay engaged on a telehealth platform. You may need to adjust how long sessions last if the child has difficulty staying engaged.

3. Be creative with building rapport with children over telehealth

Don’t be afraid to try some new and creative techniques for rapport building with your clients. Children and youth appreciate getting to know their clinician, so offer to share your environment with them and allow them to do the same. You can also take time for them show any art, journaling, or other creative projects they’ve been working on at home. Dr. McCray Ashby, Physician Engagement Director and Child Telepsychiatrist at innovaTel Telepsychiatry, also offers this piece of advice: Show off your pets!

“If I have a child that is having a hard time settling down or is really shy or guarded, I will ask if they want to see my pets, and this is often a great tool. Using my pets, I know my patients and families feel connected with me and start building a relationship with me without knowing more about me than the fact that I have a cat and a dog.” – Dr. McCray Ashby

4. Give children some control in the telehealth session

The current pandemic has created large disruptions in the lives of children and youth, and an unfamiliar treatment environment such as telehealth may add to this distress. Providing some opportunities for clients to hold control over the session can ease these feelings. Give your client an opportunity to assert control over the conversation, paying special attention if there is an audio lag that causes you to speak over each other. If you use worksheets or other visuals, allow the child to choose the pictures, colors, or fonts. Also, be sure to seek more verbal confirmations of mutual understanding of what is being done during your session that you normally might during an in-person session.

5. Involve caregivers

Involving caregivers in the session (where appropriate) can have fruitful benefits to your practice – you can provide real-time caregiver training on therapeutic techniques being provided and gain more insight into the family dynamics of the home than you might have in a typical office environment. Caregivers can also be involved in engaging the child in telehealth; for example, a hyperactive child may have difficulty remaining in the frame of the camera, but a caregiver in the room can help mitigate this behavior for you.

6. Utilize your platform’s capabilities

Many telehealth and other videoconferencing platforms offer an array of features that you can utilize in your session. You can share handouts and work through them by screen-sharing or allowing the child to show you their work on the camera. Some telehealth programs even allow you to share a “whiteboard” where the clinician and child can draw together or play games. Take time to explore the features of your telehealth platform and discover creative ways to incorporate them into your practice.

7. Recognize cultural differences

Cultural competency is necessary in any setting, but it is especially important to remember this framework when providing services via telehealth. Carefully pay attention to the verbal and nonverbal communication clues of your clients, especially if technical challenges arise. Be aware that different speech patterns and communication styles may come across differently over a telehealth platform. Lastly, be aware that different cultural backgrounds will have different experiences accessing and responding to this technology; be respectful and patient as you and your clients learn the best way to optimize this method of providing treatment.