P1011 - Novel Home Direct-to-Consumer Telehealth Solutions for Children with Mental Health Disorders

BACKGROUND/

Purpose: Mental health disorders have a high prevalence among children. Each year, 1 in 6 U.S. youth aged 6-17 experience a mental health disorder. There are many obstacles to accessing care that could be overcome by telehealth. Delivery of mental health treatment in the home can close geographical gaps and address other patient concerns, as well as provide unique diagnostic potential through visualization of the home environment. We present our initial experience with home direct-to-consumer telehealth in a metropolitan area.

Methods: In 2016, a tertiary care hospital in a metropolitan area initiated a home direct-to-consumer telehealth program through a grant supporting these services for underserved children. Encounters were conducted using a secure live video platform that could be accessed via a standard computer or tablet/smartphone application. Mental health care was provided by psychiatrists, psychologists, neuropsychologists, neurologists, and general pediatricians. All visits were tracked through a secure database. Clinical, demographic, geographic, and insurance/payment data were gathered. Satisfaction surveys were conducted with a subset of participants.

Results: Between April 12, 2016 and January 28, 2020, 1,654 patient encounters were conducted via telehealth across 22 specialty lines. Telehealth encounters for mental health were most common, making up 566 encounters. Average patient age was 14.26 years (SD = 5.79), 45.7% male and 54.3% female. The majority of patients were Caucasian (51.4%) and African American/Black (34.5%). The most common mental health diagnoses by providers using telehealth were Autism Spectrum Disorder (13.4%), Attention-Deficit Hyperactivity Disorder, combined type (13.1%), Anxiety Disorder, unspecified (11.7%), and Major Depressive Disorder, recurrent, moderate (10.1%). Excluding data from missing responses and significant out-of-state outliers, use of telehealth saved an estimated 29,897 miles for the mental health patients (M = 60.0, SD = 46.7). Distribution of miles saved is reported in Figure 1. A convenience sample of participants (N = 55) completed a satisfaction survey using a 10-point Likert scale (higher number = higher satisfaction) for scheduler convenience (M = 9.55, SD = 1.07), satisfaction (M = 9.49, SD = 1.32), and use again (M = 9.69, SD = 0.86). A selection of satisfaction survey comments is reported in Table 1. Insurance type or payment method was public (23.5%), private (41.0%), grant (15.7%), federal (18.2%), or self-pay (1.6%) with reimbursement similar to in-person services.

Conclusion: Direct-to-consumer telehealth is a feasible and acceptable care modality for a wide variety of youth mental health disorders. It can address some obstacles that patients currently face to access care and receive treatment. An increasing number of insurance companies cover direct-to-consumer telehealth. This telehealth venture has high patient satisfaction and saves patients thousands of travel miles and related time. Although these data were obtained before the COVID-19 crisis, we anticipate telehealth will have exponentially greater utilization going forward.

Presenting Author(s)

Sierra Norman

Student
Children's National Health System
Albion, Idaho
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

SA

Shireen Atabaki

Professor of Pediatrics and Emergency Medicine
Children's National Medical Center
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed

Co-Author(s)

KA

Kathleen Atmore

Clinical Director, Autism Behavioral Communication Service
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
Cara L. Biddle

Associate Division Chief
Children's National Hospital
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
MD

Marc DiFazio

Medical Director Ambulatory Services
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
DF

Daniel Felton

Complex Care Specialist
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
EF

Eduardo Fox

Pediatrician and Telehealth Expert
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
DM

Donna Marschall

Director, Whole Bear Care: Primary Care Behavioral Health Services
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
JN

Julie Newman

Pediatric Neuropsychology
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
Adelaide S. Robb

Chair, Psychiatry and Behavioral Sciences
Children's National Health System
Washington, District of Columbia
Disclosure: Allergen (Consultant, Grant/Research Support)American Academy of Child and Adolescent Psychiatry (Honorarium)American Academy of Pediatrics (Honorarium)Eli Lilly (Stockholder/Ownership Interest (excluding diversified mutual funds))Glaxo Smith Kline (Stockholder/Ownership Interest (excluding diversified mutual funds))Johnson and Johnson (Stockholder/Ownership Interest (excluding diversified mutual funds))Lundbeck (Grant/Research Support)NCATS (Grant/Research Support)NICHD EKS (Consultant)NIMH (Grant/Research Support, DSMB)NINDS (Grant/Research Support)Pfizer (Consultant, Grant/Research Support, Stockholder/Ownership Interest (excluding diversified mutual funds))Supernus (Consultant, Grant/Research Support)
CR

Cecilia Rowland

Psychology Counsellor
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
Rachel E. Selekman

Associate Director of Ambulatory Telemedicine, Assistant Professor of Pediatric Urology
Children's National Hospital
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
AS

Ariella Slovin

Community Pediatrician
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed
MS

Mark Stein

Director of PEARL Clinic and ADHD and Related Disorders Program
Seattle Children's
Washington, District of Columbia
Disclosure: CIngulate (Consultant)Genomind (Consultant)Mind Medicine (Consultant)Shire/Takeda (Consultant, Grant/Research Support)Supernus (Grant/Research Support)
JS

John Strang

Director, Gender and Autism Program
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed

Senior Author(s)

CS

Craig Sable

Associate Chief Cardiology
Children's National Health System
Washington, District of Columbia
Disclosure: No Financial Relationships Disclosed