via Innovative Technological Solutions

Live interactive videoconferencing and other technologies offer innovative opportunities for effective delivery of specialized child and adolescent mental health services. In this article, an example of a comprehensive telepsychiatry program is presented to highlight a variety of capacitybuilding initiatives that are responsive to community needs and cultures; these initiatives are allowing children, youth and caregivers to access otherwise-distant specialist services within their home communities. Committed, enthusiastic champions, adequate funding and infrastructure, creativity and a positive attitude represent key elements in the adaptation of this demonstrated user-friendly modality. It is consistently documented that almost 20% of children worldwide have one or more mental health disorders (Waddell and Shepherd 2002; World Health Organization 2003). A similar prevalence rate applies in the province of Ontario, but only one in six receives services (Offord et al. 1987). In Ontario, the ratio of child psychiatrists to children and youth with mental health needs is approximately one to 6,148 (Steele and Veitch Wolfe 1999), which is much lower than an estimated need of one to 1,390 (Thomas and Holzer 2006). Estimates of young people with psychological or psychiatric problems who are seen in primary care range from 15 to 40% (Clatney et al. 2008; Hilty et al. 2009; Stretch et al. 2009). Consequently, a large burden of responsibility for children’s mental health falls on family practitioners, pediatricians, nurses and nurse practitioners (Myers et al. 2008), social workers and child and youth workers (Provincial Centre of Excellence for Child and Youth Mental Health 2006), many of whom feel inadequately trained, ill equipped and uncomfortable in both recognizing and managing child and adolescent psychiatric disorders (Fremont et al. 2008; Paing et al. 2009). Geographical, economic and cultural factors often impede access to specialized children’s mental health services (Kelleher et al. 1992; Letvak 2002). In sparsely populated areas, costs associated with travel and time off work pose barriers to accessing care. Furthermore, it is difficult to recruit and retain specialists and allied healthcare workers, who tend to concentrate in larger urban areas (McCabe and Macnee 2002). For example, although 30% of Ontario child psychiatrists are involved in some outreach activities, only 10% venture more than 150 kilometres from their base practice (Steele and Veitch Wolfe 2006). The shortage of resources and support services in rural communities means that children requiring urgent attention are often placed in residential care outside of their home community (Sheldon-Keller et al. 1996), compromising familiar psychosocial and cultural strengths and supports. Thus, the provision of psychiatric services to children and their families in rural and remote regions must address geographical barriers to access (Boydell et al. 2006) and the distribution of scarce specialist resources, with attention to the cultural contexts of individual communities. Creative and innovative solutions responsive to these needs and challenges are required. The Canadian Standing Senate Committee on Social Affairs, Science and Technology (2006) recommends that telepsychiatry be used in rural and remote communities for consultations, education and training of mental health practitioners. The term telepsychiatry designates psychiatric applications employing live, interactive videoconferencing (Myers and Cain 2008), making it possible for two or more individuals any distance apart to interact in real time, and is emerging as one of the most successful uses of this technology (Brown 1998; Ruskin et al. 1998). With interactive technologies, extending the boundaries of the medical home base and improving communication with children and adolescents experiencing mental health challenges and their caregivers are now realizable goals (Spooner and Gotlieb 2004). In this article, a description of an operational telepsychiatry program is presented to illustrate the components that foster success. Case Report: The TeleLink Mental Health Program In 1997, The Hospital for Sick Children (SickKids), in Toronto, Ontario, undertook a pilot project to provide support to primary care settings through videoconferencing. Fully operational in 2000, the program subsequently evolved to become the TeleLink Mental Health Program (Pignatiello et al. 2011). The program’s mission is to enhance the knowledge, skill set and confidence of children’s mental health practitioners using videoconferencing and other technologies by providing timely, equitable access to bilingual (English and French) specialist services. Guided by the strategic directions of SickKids (excellence, integrity, collaboration, innovation, integration of care, research and education) and its academic affiliation with the University of Toronto, TeleLink is committed to matching community needs with best evidence and excellence in care through a range of innovative and responsive service delivery models. Particular attention is paid to fostering partnerships with stakeholders aligned with unique local cultures. Operationally, the videoconference connection between recipient “far” sites and the TeleLink hub site occurs via Internet protocol (IP) or occasionally integrated services digital network (ISDN) carried on a maximum of three lines (maximum bandwidth 384 kilobits per second). Two or more sites can be connected simultaneously, and videos, PowerPoint presentations and scanned documents can be transmitted. Recording of sessions is possible but not done routinely for clinical services. The hub site is equipped with five stationary studios, with all configurations allowing both hub and far sites to be viewed simultaneously. Core hub site staff (Figure 1) and a desigPh ot o cr ed it: is to ck ph ot o. co m

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