Telehealth to Treat Substance Use and Mental Health Problems: What Families Need to Know

The COVID-19 pandemic has disrupted many of life’s normalcies, including our traditional ways of receiving health care. As a parent, family member or caregiver of a child who is seeking support for mental health or substance use issues, figuring out how to get them the care they need during this time may be more challenging. This is where telehealth comes in. Telehealth is a combination of tools, including video-chat, text messaging, mobile apps, websites and more that help you get support from your own home.

The telehealth movement has been growing over the past 20 years, but this shift largely occurred outside of traditional care because it did not fit with how treatment providers offer services and get reimbursed by insurance companies. Our current situation, however, has allowed for screening, counseling (whether for individuals or groups), prescribing and monitoring medications and more to be available via telehealth. One of the most important things to remember is that telehealth is not a lesser version of in-person care, but rather a different version. Understanding the benefits and drawbacks of telehealth will help you decide how to best use these services for you and your family.

How Does Telehealth Work?

Telehealth provides you and your child many opportunities to connect with varied support options. Texting, video chatting, phone calls and mobile apps are just a handful of ways individuals can seek care.[1] For example, you can receive targeted text messaging and calls on your cell phone, and you can also use your computer for real-time video chatting. Additionally, many doctors’ offices utilize software to communicate at your convenience.[2] While there are limits to not physically being with a provider, group or peers, telehealth does offer several key benefits to you and your family.

Telehealth Works at Your Comfort Level

Telehealth gives you and your child the opportunity to share information about yourselves, while engaging with specialists at your pace and comfort level. If your child is reluctant to speak with a provider face-to-face, automated, targeted texting could be an option for them to reveal aspects of their history over time. Children also may be more comfortable communicating over their phone because their phones are familiar to them.[3] Similarly, if you or your child are not ready to work with someone face-to-face, phone calls can come before videoconferencing.

There is a great deal of evidence that people disclose more information using digital technology than in person, allowing for greater connection in a shorter period of time. Being in the comfort of your own home may make your child more relaxed and receptive to receiving support. As a result, using telehealth may provide you and your child the opportunity with advantages to take on support in ways not offered when accessing care solely in person.

Telehealth is Always Available

Telehealth is available 24/7, as opposed to in-person care, which is typically limited to providers’ work hours and schedules, giving you and your child the opportunity to access care when you need to, or to chat at the same time. Unlike in-person visits, you can have an ongoing conversation via text message when each of you are free. Also, if you have a formal session, scheduling is generally more flexible via telehealth.

Increased Accessibility and Opportunities to Engage

Not everyone will have the same level of accessibility to every form of telehealth and some families will have limitations. Lack of internet access can have a significant impact on a family’s ability to receive care. Phone access is generally more available than computer access, however, and providers can work to provide families in need with phone funds if necessary to help resolve some of these limitations.[4] Telehealth can also help bridge the physical gap between providers and families, especially for those living in an isolated community or where a lack of transportation can impact their ability to seek care. [5]

Privacy

As a parent or caregiver, it is important to recognize the issue of privacy, both in online security and between you and your child. Providers are usually only permitted to use secure software in communicating with your family online, as well as in keeping confidential records. It’s a good idea to check with each support or provider group to ensure they are following best practices in maintaining privacy standards.[6]

You may want to have a conversation with your family regarding the privacy of sessions, particularly if you are living in close quarters with nowhere else to go. Try and make sure that you and/or your child have separate physical spaces for calls, video chats and other telehealth services. Keep in mind that texting and mobile apps can provide a level of confidentiality within your own home that may be particularly helpful to ensure privacy as you would under different circumstances.

The Drawbacks of Telehealth

There are many advantages to telehealth care, but there are also some drawbacks. While many of the platforms used are HIPAA compliant (e.g. Doxy.me and VSee), some providers use platforms that are not, such as Facetime. Also, the ease of text messaging allows another person to use your phone and exchange messages as if they were you. To address this, providers may require a code to be entered before messages are exchanged, and one that is only known to you.

Some health care providers may not be as technologically savvy and in many cases, are working from home during COVID-19, where privacy may not be guaranteed. It can be more difficult to assess how well someone is responding to care – especially over phone or text – through digital services versus spending time with them in an office setting.

Many treatment programs now offer group therapy online, and in some cases, for extended hours.  Sitting in front of a screen for long periods of time can become tedious and some participants may find it difficult to stay engaged. It can also be harder to virtually connect with others in a group than in person. Screenings for substance use, which are commonly used in outpatient programs, may now be less frequent or eliminated.

Telehealth furnishes us with the opportunity to connect with providers, groups and peers in ways that may go beyond the COVID-19 pandemic. The benefits of increased accessibility and comfort may have many positive effects on your child’s care, and they can be utilized even after we are more readily able to access in-person support. Please remember that it’s important to interview prospective providers or treatment programs to ensure they are providing quality, evidence-based services regardless of the technology used.

[1] https://kidshealth.org/en/parents/telemedicine.html; https://www.ama-assn.org/practice-management/digital/ama-quick-guide-telemedicine-practice

[2] https://www.netrc.org/mhealth.php

[3] https://www.nami.org/Blogs/NAMI-Blog/November-2017/Telehealth-Transforming-Child-Mental-Health-Care

[4] https://for-ny.org/wp-content/uploads/2020/04/Assurance-Wireless-Program.pdf

[5] https://www.ruralhealthinfo.org/toolkits/telehealth/2/specific-populations/children

[6] https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html