Running head: USING TELEPSYCHIATRY TO TREAT CHILDREN WITH ADHD 1

Using Telepsychiatry to Treat Children With ADHD

Karen Huacasi

University of San Diego

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Using Telepsychiatry to Treat Children With ADHD

One of the most common mental health disorders in children is attention

deficit/hyperactivity disorder (ADHD) (National Institutes, 2010). Children with untreated

ADHD often experience problems in school, troublesome relationships with family and

classmates, and low self-esteem issues (Leslie, 2002). Some common barriers to adequate

management are non-adherence to medications, inappropriate treatment plans, and lack of

pediatric psychiatrists in surrounding area. Telepsychiatry helps overcome these barriers by

allowing patients to receive care at an accessible location and reducing delays in care

Background and Assessment

Ukiah Health Center is a community health center that serves the adult and pediatric

population in rural Ukiah, California. Many pediatric patients at this clinic have ADHD.

However, specialty mental health services are unavailable. Currently, the child’s primary care

provider manages ADHD therapy. However, providers do not have enough time to treat these

patient’s regularly or adequately. Survey results showed that caregiver perception of patient

improvement is poor. When caregivers are discouraged, they tend to miss or cancel their

children’s appointments more frequently (Larson, 2011). This has resulted in a loss of revenue

for the clinic. Worst of all, patients are not receiving the quality care they need. Three main

problems have been identified. First, most families are unable to drive three hours to the nearest

pediatric psychiatrist. Second, the clinic is so busy that follow-up appointments can only be

scheduled once a month. This is inadequate because ADHD medications need to be titrated

weekly or biweekly at the beginning of pharmacotherapy (Shier, Reichenbacher, Ghuman,&

Ghuman, 2013). Finally, 15-minute appointment slots are barely sufficient for the provider to

fully assess the patient, speak to the parents, and formulate a revised and effective plan.
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Proposal

The proposed solution to this challenge is Genoa telepsychiatry. Telepsychiatry is the

electronic delivery of psychiatric services to patients. Research shows that real time

telepsychiatry is a reasonable alternative to an office visit for underserved children with ADHD

(Palmer et al., 2010). After implementation of Genoa telepsychiatry, patients will schedule a real

time telepsychiatry appointment, come to the clinic, and enter a private room set up for a

videoconference with a mental health specialist. The remote specialist will then provide a

psychiatric assessment, pulling together direct observations and VADRS-Caregiver and Teacher

scores, to prescribe the most therapeutic medication schedule. The visit can last 30 minutes to an

hour depending on the complexity of the patient condition.

Genoa is a browser-based telepsychiatry platform and service that is equipped to meet the

specific needs of this clinic and population. Genoa’s protocols exceed the technical safeguards

set by the Health Insurance Portability and Accountability Act. It is cost-effective as it allows the

clinic to hire a remote specialist on an hourly basis, instead of hiring a full-time onsite specialist.

It is expected that with less ADHD patients on the clinic waitlist, operational efficiency and

patient satisfaction will increase and more patients will receive the care that they need.

Conclusion

Children living in rural, underserved areas are often deprived of access to ADHD specific

care. Telepsychiatry can help bridge this gap so that more children can have access to high

quality care. Using Genoa telepsychiatry patients will have access to longer, more frequent visits

with a mental health specialist. Patient’s are expected to have better outcomes and an improved

quality of life. Patients, caregivers, and providers will all benefit from the implementation of

Genoa telepsychiatry at Ukiah Health Clinic.

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References

Larson, J. J. (2011). Influence of Caregivers Experiences on Service Use Among Children With

Attention-Deficit Hyperactivity Disorder. Psychiatric Services, 62(7), 734-739.

doi:10.1176/appi.ps.62.7.734

Leslie, L. K. (2002). The Role of Primary Care Physicians in Attention Deficit

Hyperactivity Disorder (ADHD). Pediatric Annals, 31(8), 475–484.

National Institutes of Health. (2010, October). NIH Fact Sheets - Attention Deficit Hyperactivity

Disorder (ADHD). Retrieved April 02, 2018, from

https://report.nih.gov/NIHfactsheets/ViewFactSheet.aspx?csid=25

Palmer, N. B., Myers, K. M., Vander Stoep, A., McCarty, C. A., Geyer, J. R., & DeSalvo, A.

(2010). Attention-Deficit/Hyperactivity Disorder and Telemental Health. Current

Psychiatry Reports, 12(5), 409–417. http://doi.org/10.1007/s11920-010-0132-8

Shier, A. C., Reichenbacher, T., Ghuman, H. S., & Ghuman, J. K. (2013). Pharmacological

Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents:

Clinical Strategies. Journal of Central Nervous System Disease, 5, 1–17.

http://doi.org/10.4137/JCNSD.S6691
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