The Kids Are Not OK: Telehealth May Help

Friday, September 22 2023

Long before COVID-19, children and teens in the U.S. struggled with their mental health.  Sadness, hopelessness, and suicidal thoughts increased sharply among adolescents in the last decade, according to CDC data.  Yet research based on the 2016 National Survey of Children’s Health found that half of the estimated 7.7 million children and teens with a mental health condition didn’t receive treatment.

COVID-19 only increased these challenges. Six months into the pandemic, one-third of parents said their child’s mental or emotional health had gotten worse; almost half said the pandemic made it more likely they would seek treatment for their child.  

Social isolation, loneliness, stalled life plans, financial insecurity, and abuse may all have contributed to an unprecedented spike in mental health problems in kids and teens during the pandemic. Among the most affected have been children of color and LGBTQ+ youth. 

Telehealth as the “entry point” into mental health care 

One bright spot in an otherwise dark picture is the expanded use of telehealth for kids. This was the result of relaxed telehealth regulations and belated recognition of glaring inequities in mental health care. Children in large swaths of the country may live hundreds of miles from the nearest therapist. In fact, over 60% of rural counties don’t have a single psychiatrist. 

Even in cities, there are multiple barriers to care, including lack of insurance, transportation, and child care. Telehealth solves some but not all of these problems. For example, the rollout of free telemedicine hasn’t gone smoothly and usually only applies to those with insurance. And millions of families in the U.S. have spotty or no internet access. Still, experts say that for some kids, telehealth may be the “entry point” into mental health care. 


How telehealth helps

Many studies have shown that virtual therapy is just as effective as in-person treatment and has higher retention rates. In a recent poll of parents who used telehealth for children, the majority said their child benefitted, and the experience was positive. Most said they would stick with telehealth, even when they could resume in-person treatment.

The benefits of telehealth for children and teens include: 

  • Lots of kids are in therapy because of circumstances going on at home. It can sometimes be easier to discuss and work through them where they happen. 
  • Home also might seem more private than an office so that kids may feel more comfortable speaking openly.  They may also feel there’s more safe space between them and the therapist. Kids can even create their own safe space, complete with toys, art, pets, and snacks (as long as these aren’t distracting.)
  • Many kids and teens communicate with their friends through texts and video chat, so these formats are familiar. 


Building rapport

Telehealth is different from in-person therapy and may take some getting used to. Some days may be better than others, especially as you work through technical glitches. Children’s symptoms may also have gotten worse during the pandemic. 

Despite these challenges, evidence and clinical experience suggest that therapists can build rapport and a strong therapeutic alliance with children using telehealth.  If you’re a therapist working with children virtually, here are some tips to help build rapport: 

  • Establish ground rules, so clients feel they have some control over the conversation, and you don’t talk over each other.
  • Use universal gestures like virtual high 5s and thumbs-up when appropriate.
  • Ask younger children to draw pictures or use dolls or action figures to help tell a story. 
  • Take turns answering questions, such as “What’s your favorite food?” and “What’s your favorite sports team?”
  • Use the same casual language your clients do.
  • Just talk with each other. It’s a proven way to build rapport.

Keep kids engaged

It’s not easy for young kids to sit still for an hour, especially if they are diagnosed with ADHD. It may also be confusing for them to see someone they’ve known in person on a screen. Be flexible about how long a session should last and how much moving around you allow. These ideas can help:

  • Use art-based projects to capture the attention of younger kids.

In your first session, find out what craft supplies they have on hand, such as paper, markers, and crayons. Ask them to keep these in a basket, so they’re easy to grab each time. 

  • Get to know the platform you use. It may have a feature that allows you and your client to draw at the same time.
  • Use puppets and toys to help preschoolers express their feelings. 
  • Use videos, music, and social media to guide your conversations with older kids and teens.

Investigate what works best with your clients

Many services for kids with special needs dried up during the pandemic, and they may need extra help right now. Work with your client’s family to find adaptations that bring the most benefit. For example, a child diagnosed with an autism spectrum disorder might do better when you recreate in-person treatment as much as possible. You can help kids who need a lot of sensory input by incorporating clay or scented markers into your sessions.  There are workarounds for most telehealth challenges, though some therapists may need to do a little extra investigating to find what works best with their clients.


Support parents and caregivers

Children aren’t the only ones under stress. During the pandemic, many adults have had to confront job loss, income insecurity, and the threat of serious illness. They’ve had a year of juggling remote schooling, child care and work without their usual support systems. All these stressors can negatively affect a parent’s mental health and well-being, which can take a toll on kids. Check in with your clients’ parents or caregivers, offer extra support, and encourage them to take care of their own mental health.

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