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Telepsychiatry Brings Low-Cost Care to Underserved Communities

By Elizabeth Duffrin on Wednesday, March 11, 2009

Children who need psychiatric care often face roadblocks to getting it, especially in low-income communities where the national shortage of child psychiatrists is most acute. Travel time discourages some families from seeking care. Long waitlists deter others, as does the stigma of mental illness itself.

A new service arriving soon at Chicago’s five Elev8 schools aims to provide students with quicker access to psychiatric care in a more reassuring environment. Called “telepsychiatry,” the service will allow psychiatrists to confer with patients across a video conferencing system located at their school health centers.

“People often do feel stigmatized walking into the office of a psychiatrist,” said Dr. Carroll Cradock, director of Behavioral Health Services at Advocate Illinois Masonic Medical Center, an Elev8 partner. “That’s the beauty of school-based health. Kids don’t have to walk into a mental health center to get care. They can walk into a health center.”

As an added benefit, she noted, telepsychiatry will allow medical providers to communicate directly with a child’s psychiatrist, reducing the risk of dangerous drug interactions.

The need for improved psychiatric care is critical in Elev8 communities, school staff agree. Children’s issues range from attention deficit disorders, to depression, to serious behavioral problems.

“There are a lot of anxieties that kids have,” explained David Rodriguez, social worker for Ames Middle School in Logan Square. “It’s a gang area. Kids are aggressive and fighting. We have kids who have panic attacks, girls who are self-mutilating.”

When mental illness goes untreated, it can slow the academic progress not only of the child afflicted but of his or her entire class, observed Meryl Sosa, executive director of the Illinois Psychiatric Society. “Their distraction can impact [others] and all of a sudden you have kids turning their heads every which way.”

Elev8 school health centers are likely the first to offer telepsychiatry to students in communities on Chicago’s underserved South and West Sides, according to staff at the Illinois Coalition for School Health Centers. (Illinois Masonic formerly offered the service at two North Side school health centers, but they opted to discontinue it because their proximity to the medical center made it unnecessary, clinic staff reported.)

Telepsychiatry has about a 10-year track record, but is just catching on in Illinois, said Sosa. The state has only required Medicaid to cover it since 2007. Other states, including Arizona, Maine and Minnesota, use it extensively as does the federal Veterans Administration, she said. In Chicago, Illinois Masonic has offered it for many years to deaf clients who needed a psychiatrist fluent in American Sign Language.

Research has shown that compared to in-person therapy, telepsychiatry is actually a more effective way to reach adolescents, according to Sosa. “They are very used to being at a computer screen,” she explained. “It also puts a little bit of distance between them and the psychiatrist, and that makes it easier to deal with.”

Quicker access to care through telepsychiatry also will make it more likely that children receive needed medications, said Theresa Baker, a social worker at Marquette Elementary School in Chicago Lawn. Marquette’s nearest mental health facility has a waiting list, and hard-working parents are sometimes reluctant or unable to travel across town to another provider, she explained. As a result, behaviors can escalate to the point where children require hospitalization, she said.

Locating psychiatric services at the school will also simplify communication between the psychiatrist and a child’s teachers and medical providers, resulting in more effective treatment, said Rodriguez of Ames. “If a child is on medication we’re going to be monitoring that and give immediate feedback: Is the medication working? Is it helping this kid?”

In addition, school and health center staff can serve as patient advocates, helping ensure that medications are not prescribed unnecessarily and that parents understand potential side effects, Rodriguez said.

Elev8’s telepsychiatry equipment will be purchased with a $35,000 grant from the VNA Foundation and in place by June at three schools – Ames, Marquette and Perspectives-Calumet Middle School in Auburn Gresham. Two more schools, Reavis Elementary School in Bronzeville and Orozco Academy in Pilsen, are expected to offer telepsychiatry beginning next fall. The service will be provided in both English and Spanish.

Sosa hopes that once the advantages of telepsychiatry become evident at Elev8 schools, it will spur Chicago Public Schools to promote its adoption elsewhere in the district. “This is the wave of the future,” she said. “No doubt about it.”