JMIR Publications

ABSTRACT

Background:

Children and adolescents living under child protection services (CPS) have complex mental health care needs. The scarcity and geographical centralization of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities.

Objective:

The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program (TCP) for the primary health care (PHC) treatment of children and adolescents living under CPS.

Methods:

We developed a TCP for two rural PHC clinics located in central Chile (Valparaíso Region) and evaluated the implementation using a mixed methods study design. The TCP consisted of videoconferencing mental health consultation (MHC) sessions scheduled twice per month (90 minutes), over a six-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We analyzed the number of MHC sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the TCP.

Results:

During the six-month study period fifteen videoconferencing MHC sessions were held. The TCP assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy, psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by primary care clinicians for improving the resolution capacity in the treatments of this patient population. Connectivity issues were limitations that could be resolved in most sessions.

Conclusions:

TCP was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a resource poor setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability over time.