Eve-Lynn Nelson

Treating Childhood Depression over Videoconferencing

Effective cognitive-behavioral treatments for childhood depression have developed over the last decade, but many families face barriers to such care. Telemedicine increases access to psychological interventions by linking the child and the clinician using videoconferencing (VC). The current study evaluated an 8-week, cognitive-behavioral therapy (CBT) intervention for childhood depression either face-to-face (F2F) or over VC. The telemedicine setup included two PC-based PictureTel systems at 128 kilibits per second (kbps). Success was defined by (1) decreasing depressive symptoms at similar rates in both the VC group and the F2F group and (2) demonstrating the feasibility of a randomized controlled trial in telemental health. Children were assessed for childhood depression using the mood section of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present Episode (K-SADS-P). Twenty-eight children were randomized to either F2F or VC treatment. The participants completed the K-SADS-P and the Childrens Depression Inventory (CDI) at pre- and post-treatment. The CBT treatment across the two conditions was effective. The overall response rate based on post-evaluation with the K-SADS-P was 82%. For the CDI total score, both the Time and the Group by Time effects were significant (p < 0.05). The interaction effect reflected a faster rate of decline in the CDI total score for the VC group. The study serves as a model for building on past research to implement a randomized controlled trial. This information provides persuasive research data concerning treatment effectiveness for clinicians, families, and funders.

Evidence-Based Practice for Telemental Health

Telemental Health Standards and Guidelines Working Group Co-Chairs: Brian Grady, MD Kathleen Myers, MD, MPH Eve-Lynn Nelson, PhD Writing Committees: Evidence-Based Practice for Telemental Health Norbert Belz, MHSA RHIA, Leslie Bennett, LCSW, Lisa Carnahan, PhD, Veronica Decker, APRN, BC, MBA, Brian Grady, MD, Dwight Holden, MD, Kathleen Myers, MD, MPH, Eve-Lynn Nelson, PhD, Gregg Perry, MD, Lynne S. Rosenthal, PhD, Nancy Rowe, Ryan Spaulding, PhD, Carolyn Turvey, PhD, Debbie Voyles, Robert White, MA, LCPC Practice Guidelines for Videoconferencing-Based Telemental Health Peter Yellowlees, MD, Jay Shore, MD, Lisa Roberts, PhD Contributors: Working Group Members [WG], Consultants [C], Reviewers [R], Telemental Health Special Interest Group Chairs [MH], ATA Standards and Guidelines Committee Member [SG], ATA Staff [S] Nina Antoniotti, RN, MBA, PhD [Chair, SG] Richard S. Bakalar, MD [SG] Norbert Belz, MHSA RHIA [WG] Leslie Bennett, LCSW [WG] Jordana Bernard, MBA [S] Anne Burdick, MD, MPH [Vice Chair, SG] David...

Feasibility of telemedicine intervention for childhood depression

Abstract Context: Childhood depression is associated with high short-term and long-term morbidity. Cognitive-behavioural therapy (CBT) for depression has been supported as an effective treatment in the traditional clinic setting. But many families face barriers to depression treatment, including distance to providers, provider shortages, stigma, and other challenges. Telemedicine or interactive televideo offers an innovative way to provide therapy at a distance. The family and therapist see and hear each other in real-time using videoconference. Objective: This pilot project evaluated the same cognitive-behavioural therapy treatment for childhood depression in two different settings — face-to-face (F2F) or over interactive televideo (ITV). Participants: Twenty-eight children with depression and their caregivers completed an eight-session, empirically supported CBT course for parent and child. Results: All parent and child CBT skills were implemented successfully over telemedicine. An 82% remission from de...

Understanding the Functional Late Effects and Informational Needs of Adult Survivors of Childhood Cancer

PURPOSE/OBJECTIVES To report functional (physical and cognitive) late effects, experiences, and information needs of adult survivors of childhood cancer. DESIGN Descriptive, mixed methods survey. SETTING Two pediatric oncology programs in the Midwest. SAMPLE Convenience sample of 272 young adult survivors. METHODS Voluntary survey completion by young adult survivors regarding late effects, experiences, and educational needs to develop appropriate comprehensive care programs for care provision before, during, and after transition to adult care. Survey domains were identified from existing survivorship literature and focused on all aspects of survivorship; however, this article focuses on results specific to the functional domain. MAIN RESEARCH VARIABLES Functional late effects, experiences, information needs, age, gender, and treatment intensity of young adult survivors of childhood cancer. FINDINGS Response rate was 48%. Functional late effects, perceptions, and information needs all correlated with intensity of treatment (those survivors most heavily treated experienced the most symptoms). Survivors wanted more information about late effects and how to deal with them. Women wanted more information about fertility-related topics, and participants who received more intense treatment generally wanted more information. Brain tumor survivors perceived greater cognitive difficulties, cognitive late effects, fatigue, and financial difficulties. CONCLUSIONS Survivors experience myriad physical late effects and require ongoing access to information as needs change over time. IMPLICATIONS FOR NURSING Identifying new and innovative ways to reach survivors and better meet needs is important for care, research, and program development. KNOWLEDGE TRANSLATION The findings of the research underscore the importance of continuous learning opportunities for adult survivors of childhood cancer. The findings also highlight the need for healthcare teams to better understand the current and long-term needs of this population. In addition to traditional communication approaches, technologies such as social media and telemedicine can provide innovative ways to deliver patient-centered care.

Rural telepsychology services for children and adolescents

Because of the overwhelming maldistribution of mental health specialists in metropolitan areas and the many underserved families living in rural settings, rural areas are natural homes for the use of telemedicine or videoconferencing technology for clinical services. The authors describe telepsychology services for rural clients, placing best psychology practices within the context of broader telemental health services. The goal is to approximate evidence-based child psychotherapy from face-to-face practice using the videoconferencing technology. Telepsychology is illustrated with a case report of a rural Hispanic teen and her family presenting through the teens primary care clinic.

Telepsychology: Research and Practice Overview

There are significant workforce shortages for psychologists with expertise in evidence-supported therapies with children, particularly in nonmetropolitan areas. Telepsychology, or psychology services delivered by real-time videoconferencing, helps bridge this access gap. This article first reviews the telepsychology literature and then builds on early telepsychology guidance for the current practice environment. The practicalities of telepsychology implementation and the lessons drawn from the more well-established telepsychiatry practice are described. The authors also provide an update to pioneering interdisciplinary telehealth principles presented a decade ago.

Using Videoconferencing to Provide Psychological Services to Rural Children and Adolescents: A Review and Case Example

Children and adolescents living in rural areas have difficulty accessing psychological services due to a lack of psychologists and other behavioral health professionals, especially those with expertise in treating youth. Telepsychology helps bridge this access gap. This article extends evidence supporting videoconferencing for psychological assessment and treatment in adults to support telepsychological treatment for youth. In addition, the basic components needed to begin and sustain a telepsychological practice are explored. Finally, a case example of an adolescent presenting with depression and disordered eating illustrates the practice of, and ethical standards needed for, telepsychology. Future technologies and applications around telepsychology are also discussed.

A Lexicon of Assessment and Outcome Measures for Telemental Health

BACKGROUND The purpose of this document is to provide initial recommendations to telemental health (TMH) professionals for the selection of assessment and outcome measures that best reflect the impacts of mental health treatments delivered via live interactive videoconferencing. MATERIALS AND METHODS The guidance provided here was created through an expert consensus process and is in the form of a lexicon focused on identified key TMH outcomes. RESULTS Each lexical item is elucidated by a definition, recommendations for assessment/measurement, and additional commentary on important considerations. The lexicon is not intended as a current literature review of the field, but rather as a resource to foster increased dialogue, critical analysis, and the development of the science of TMH assessment and evaluation. The intent of this lexicon is to better unify the TMH field by providing a resource to researchers, program managers, funders, regulators and others for assessing outcomes. CONCLUSIONS This document provides overall context for the key aspects of the lexicon.

Telemedicine and adherence to national guidelines for ADHD evaluation: a case study.

The pilot project evaluated a telemedicine clinics adherence to American Academy of Pediatrics (AAP) guidelines for attention-deficit/hyperactivity disorder (ADHD) evaluation. Real-time videoconferencing linked the patients, the families, and the specialty mental health team. The ADHD Telemedicine Clinic adherence to AAP guidelines was tracked using chart data. The study included 22 patients (Mean age = 9.3 years, SD = 2.3 years) participating in 69 telemedicine visits across 13 different school-related sites. The ADHD Telemedicine Clinic reached extremely high adherence rates across the AAP evaluation guidelines for ADHD, ranging from 95-100% across the six guidelines. No factor inherent to the telemedicine service delivery mechanism impeded adherence to national guidelines for ADHD evaluation. Telemedicine-based outreach had the greatest impact on AAP Guideline #4, stating that information should be obtained from the childs academic setting. The school-based telemedicine clinic allowed increased communication across the school and specialty mental health systems and facilitated greater input across child, parent, school personnel, and mental health professionals.

A Pilot Study of Home-Based Videoconferencing for Breastfeeding Support

Background: Research on using videoconferencing for breastfeeding support is limited. Purpose: Although European case reports have described videoconferencing for providing lactation support, this was the first study to assess the reliability and feasibility of home videoconferencing for breastfeeding assessment and support in the United States. Method: The study used 4 real-time, secure videoconferencing sessions to deliver lactation support to 10 mothers in the home. To assess interrater reliability, percentage agreement was calculated on LATCH assessment scores from telehealth and home-visit International Board Certified Lactation Consultants (IBCLCs) during the first 2 visits. Participants’ perceptions of satisfaction and the overall experiences were documented. Results: The percentage agreement on the 5 LATCH score dimensions ranged between 40% to 100% during the first visit and 80% to 100% during the second visit. To assess feasibility, participants reported their satisfaction with the technology and their perceptions of the videoconference consultation. All participants “strongly agreed” that they were comfortable talking about breastfeeding concerns using home videoconferencing. Conclusion: The findings suggest videoconferencing can potentially be used to support breastfeeding mothers in their homes.