Currently submitted to: JMIR Mental Health
Date Submitted: Oct 29, 2026
Open Peer Review Period: Oct 31, 2026 - Dec 26, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The quality and safety of telehealth services in child and adolescent mental health settings across the health system: A systematic review
ABSTRACT
Background:
The implementation of telehealth for mental health has demonstrated that this model of care could effectively manage mental health needs without overwhelming traditional services. However, challenges for clinicians and clients can arise across all levels of the healthcare system, including privacy concerns, a lack of training and support, and inadequate infrastructure to support connectivity. Although the benefits and challenges of telehealth are well documented, less is known about the factors that influence high quality, safe care in child and adolescent mental health.
Objective:
This review aims to identify the strengths, barriers and enablers that impact the quality and safety of telehealth for child and adolescent mental health care.
Methods:
Four databases (EMBASE, MEDLINE, PsycINFO, CINAHL) were searched for studies published between January 2020 and April 2025 that examined psychological interventions delivered by psychologists via telehealth to individuals under 18 years with a mental health condition or diagnosis. Data were synthesised narratively to identify barriers and enablers across individual, organisational and system levels.
Results:
Twenty-three studies were included (quasi-experimental, n=17; randomised control trials, n=2; mixed methods, n=2; qualitative, n=2). Ten studies used video-only modalities, nine combined video and telephone, and four employed hybrid models of care. Clinical areas included neurodevelopmental conditions, behavioural issues, anxiety and trauma. Models of care encompassed individual and caregiver therapy, group interventions, assessment, management, and outpatient programs. Key individual-level barriers included sensory distraction and developmental suitability, while organisational enablers included adaptable protocols and clinician training.
Conclusions:
Telehealth improved access to services, particularly for families in geographically remote areas, however, suitability varied across client groups. Younger children, caregivers with limited digital literacy, and individuals with complex presentations were less well supported, whereas those receiving evidence-based, manualised interventions experienced the greatest benefit. Overall, telehealth quality and safety depend on tailoring care to client complexity and on interactions across individual, organisational, and system-levels. When implemented in a client-centred, context-responsive manner, telehealth represents a viable alternative to in person care. Clinical Trial: PROSPERO CRD420251023567; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251023567
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.