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Treating Children Via Telehealth

– Caila Holm, MSW

The COVID-19 pandemic inspired many shifts in how we live our daily lives. The Steven A. Cohen Military Family Clinic at Centerstone operated remotely for 15 months. During that time, clinicians and clients challenged previous assumptions about the limitations of telehealth. Following the return to seeing in-person clients in May 2021, our clinic still maintains a large caseload of virtual clients with one notable exception: children. Adults and adolescents choose telehealth to make therapy more accessible to fit into their busy lives. There are also clients who live too far from our clinic, or in areas with little access to comparable mental health care. Telemedicine allows these clients to receive the same high-quality treatment that they would if they walked into our brick and mortar clinic. Children can experience some of the same benefits that adolescents and adults do by engaging in telehealth, yet caregivers understandably often have concerns about taking this route. Lets address some of the most common concerns:

I don’t want my child in front of ANOTHER screen. Screens in many forms seem to have permeated our world and they are hard to avoid. Caregivers often struggle with deciding where the line should be drawn. Perhaps the problem isn’t the screen itself but rather the content on the screen and lack of physical and mental stimulation often seen during “screen time”. Utilizing screen time intentionally and balancing it with other activities allows caregivers to accept the reality that screens are an important part of their child’s life, while also setting important boundaries and modeling an appropriate balance between times online and offline. By engaging in teletherapy, the child learns to associate the screen not with mindless television or conflict with caregivers about the use of screens, but instead the child can conceptualize the screen as an important tool where school, healthcare, and even social relationships can be delivered and maintained.

My child won’t be able to focus or sit still. Teletherapy doesn’t necessarily mean sitting in front of a screen motionless. Our clinic has many experienced virtual clinicians who utilize a variety of engaging interventions from yoga and playing games to watching videos and dancing—all of which effectively deliver our heavily research-supported Evidence Based Practices. While many mental illnesses of childhood exhibit symptoms such as fidgeting and flight of focus, learning how to cope with these behaviors as they occur in real time can be very powerful. Sometimes such behaviors are developmentally appropriate in younger children. Often mental health treatment of very young children (0-5) occurs with a caregiver in the room anyway, so this regulated other can help guide their child to engage in treatment. At the end of the day, we do defer to the caregiver’s judgement because caregivers are the experts in their children, but we want to join with caregivers to thoroughly assess together if telehealth is a viable option for their child.

My child won’t be able to form a connection with their therapist virtually. The current generation of caregivers mostly grew up with limited access to social media and the like. Connections made in person were the norm. It is important to acknowledge that the upcoming generation will have a different experience. Interfacing with people virtually and developing relationships in that way is likely going to be a large part of your child’s life experience. Learning what a healthy relationship online looks like could be very beneficial and protective for children growing up in the digital age. Telehealth can be thought of as a way to help your child develop appropriate social skills specific to virtual relationships.

My child won’t feel comfortable enough to talk about what they need to talk about. This is an important consideration that all of our clinicians thoroughly discuss with clients when engaging in telehealth. A vital component of making telehealth effective is ensuring the privacy of the client and replicating the therapeutic environment in the home as much as possible. This effort is largely the responsibility of the client and their family. While some clients find therapy from home much more comforting and safe, other clients have distinct barriers that might make telehealth difficult: large number of people in the home, thin walls, fears of being overheard, inability to locate a private space, etc. Our therapists work with clients to problem-solve and figure out the arrangement that will make telehealth most effective for the client, the therapist, and all other involved parties.

There are always varied concerns when it comes to conducting telehealth, such as technological and connectivity limitations, but the items discussed above are some of the most common yet also the most easily addressed when it comes to children. When engaging in telehealth with your child, the legal parent/guardian of the child is expected to not only be present in the home, but likely a participant in treatment as well. Our clinicians rely on caregivers for additional perspectives, weekly measures, monthly treatment plan reviews, safety planning (as needed), and any clinically indicated family interventions. It is important to remember that when your child engages in services, so do you. Enrolling your child in teletherapy is a great way to increase access to many of the Steven A. Cohen Military Family Clinic at Centerstone’s highly trained clinicians that might not otherwise be available for in-person services. Some of our remote staff have specialties that might fit your child’s particular needs perfectly, and such a fit might not be found with in-person staff. When you schedule your child’s intake, please ask your Intake Coordinator about telehealth with children and discuss what options might suit your child’s needs best.

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