Tele-Behavioral Health: COVID-19 and Child and Adolescent Mental Health Care

Expert Q&A with Rick Leichtweis, PhD, Executive Director, Inova Kellar Center

Rick Leichtweis, PhD, serves as Executive Director for Inova Kellar Center. He is a leader in the educational and mental health field and has extensive experience in developing mental health and substance use disorder treatment and special education programs.

Across the U.S., and here in Northern Virginia as well, children and adolescents had to transition to virtual education, homeschooling and social distancing in response to COVID-19. For some youth, these changes have created anxiety or depression that may need to be addressed.

We are checking in with Rick Leichtweis, PhD, Executive Director, Inova Kellar Center for an update on Inova’s response to help children, adolescents, and their families to continue to cope and flourish in the ‘new-normal’ of child and adolescent tele-behavioral health.

Q: What is tele-behavioral health?

Tele-behavioral health is a therapy session with a health provider that occurs through the use of technology instead of in person. Telehealth enables providers to begin or continue treatment during times when face-to-face sessions are not available.  At Inova Kellar Center, individual, family and group therapies occur throughout the day, providing a continuity of care that is critical to a youth’s success.    

As with all new experiences for children and adolescents, it is important that they understand what telehealth is, how it will be used and who will be involved, so they are prepared and have their questions or concerns addressed. Adolescents in particular want to be assured that their conversation with the therapist or physician is going to be private, following the parent attending the beginning of the session.

The parent must attend the session’s start, so the provider is aware of who is at home with the child in the event the child needs immediate support and supervision. The clinician will provide education and support around questions the parent or child may have during the initial telehealth appointment and will set the guidelines and expectations in using a virtual platform. Most children and adolescents adapt quickly to the telehealth platform and are comfortable with the technology. 

Q: Is tele-behavioral health care an effective solution for continuing access to mental health care for children and adolescents during COVID-19?

Absolutely. Telehealth provides a safe and effective alternative to face-to-face therapy when that is not possible, as in the case of COVID-19.  Without a break in treatment, the child can continue to work with the clinician on those issues most critical to the child’s mental health concerns.

Particularly in a time of national crisis, continuing or obtaining this support can have a significant impact on how the child will do after COVID-19.  Most children by nature are social beings and need interaction with others to develop and grow. A major interruption to that lifestyle can challenge even the most resilient children. Having a trusted outlet to help them develop coping skills to successfully negotiate the post-COVID-19 world can make a significant difference in their lives.

Q: Is there any limit to what types of therapy are conducive to telehealth therapy?

Most treatment modalities can be provided using telehealth. Children and youth who do well in face-to-face therapy should transition well into the virtual experience. Some children with ADHD or autism spectrum disorders may have more difficulty than others, so we focus on working with the parent/caregiver to help them effectively support their child. In addition, patients who are actively engaging in self-harming behaviors or are experiencing suicidal thoughts with intent are generally not good candidates for this intervention because of safety concerns. 

Q: How has Inova Kellar Center adjusted its approach in response to the shift from in-person to virtual mental health group therapy in the Partial Hospitalization Programs and Intensive Outpatient Programs?

Using telehealth for more intensive programming has proven to be more effective than once thought. Our Intensive Outpatient Programs (IOP) meet three to four times a week for three hours each day in groups of eight to 10 adolescents. Our Partial Hospitalization Programs (PHP) hold sessions throughout the day, five days a week. Both interventions can be provided virtually to most typical IOP patients and to a select group of PHP patients, depending on safety concerns. 

Some may think that it would take less staff to provide these interventions.  However, the reality is that if the intervention is going to be provided in the safest manner, it can actually require a higher level of staffing.  For groups at Inova Kellar Center, at least two providers are assigned to each group. One therapist is leading the group while the other functions as a “hall monitor,” constantly observing behaviors of the patients, monitoring waiting rooms, looking for potential hackers, pulling a patient out into a one-to-one conversation for additional support, and contacting the adult present in the home in the event of a emergency or crisis.  Just as with face-to-face groups, safety and constant surveillance of the group members is critical. It can be a staff-intensive intervention if done safely, particularly for the PHP groups where the adolescents are experiencing more acute concerns.

Q: How can families prepare for tele-behavioral health visits?

Inova Kellar Center requires a parent or responsible adult to be present in the home at all times during a telehealth visit. The clinician verifies the adult’s presence at the beginning of each session and has a cell phone number that can be called in the event of an emergency. It is important that the child is prepared for the session and online at the time of the appointment to ensure maximum benefit. A quiet, private space is necessary for the patient to feel comfortable sharing with the therapist or physician, and the child needs to feel safe in that privacy. Often the parent will join the session at the end to discuss any “homework” or thoughts about the sessions and to schedule follow-up appointments.

Q: When will it be okay to resume in-person therapy and programs? How long will tele-behavioral health appointments continue?

Face-to-face services will begin to resume slowly as we begin to reopen our communities. Detailed planning is occurring now in preparation for reopening treatment services and programs at Inova Kellar Center. 

Appropriate safeguards must exist to ensure everything possible is being done to maintain a healthy patient population and to protect the staff from any potential infection. We are integrating all CDC recommendations and mandates into our policies and procedures, obtaining appropriate PPE and developing staff training. Once all this is in place, a slow reintroduction back into the facility will begin, starting with the most acute and higher-risk patients. As the organization develops and settles into effective workflows to maintain a safe environment, more services will be introduced.

Q: What can families do to support their kids’ mental health during COVID-19?

• In terms of nurturing your kids and providing added support during the health pandemic, some tips include:
  • Have your child on a schedule each day for several hours with breaks
  • Monitor screen time and social media
  • Be creative about exercise and playtime
  • Respect privacy, though monitor for isolation
  • Enlist self-care strategies to help cope with the stress of managing children, work and possibly extended family
  • Support social distancing
  • Actively participate in distance learning programs
  • Talk to the child’s teachers often, if possible
  • Require healthy habits, particularly hand washing
  • Encourage healthy choices (e.g., a consistent sleep schedule)
  • Validate feelings and acknowledge  disappointments – graduation, proms, sports, friends
  • Have virtual family meetings with family members
  • Stay positive and optimistic about the future
  • Honor others on the front lines of COVID-19
  • Reach out for help when you need it

Q: What stress factors at home during COVID-19 can be brought to child and adolescent tele-behavioral health therapy?

All COVID-19-related concerns are appropriate to bring up during a session. There is a great deal of fear, anger and disappointment associated with the current environment, and it’s important to talk about these issues. Living in close quarters for so long is a challenge for any family. Bring these concerns to the sessions and get support and ideas as to how best manage during this time. There is help out there, and telehealth is a wonderful opportunity to get the support parents and children need.

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Learn more about Inova Behavioral Health Services, and find a list of locations. For child and adolescent behavioral health outpatient services, call 703-218-8500. For inpatient adolescent behavioral health inpatient services, or adult mental health and substance use services (both inpatient and outpatient), call 703-289-7560.  

Inova Kellar Center provides a full continuum of outpatient services and programs, including individual, family and group therapy, medication management, psychiatric evaluations, psychological testing, intensive outpatient programs, and partial hospitalization programs.