TABLE 44–4. Models of care in child and adolescent
Consultee-centered consultation (PCP attends session
Empowers PCPs and provides opportunity for PCPs' learning.
PCP retains responsibility for all patient care and thus ensures continuity
Optimal communication between PCP and telepsychiatrist.
Convenient for patient.
Referring PCP must take time from practice.
Minimizes opportunities for repeated sessions, which are often
necessary to understand needs.
Unclear patient comfort with both physicians attending the
Helpful for emergent and urgent care and to augment
Mostly practiced in international sites (e.g., Canada).
Client-centered consultation (PCP does not attend session
Families can present problems in their own manner for expert
Provides optimal privacy.
Variable number of sessions to adequately cover the data base.
Helpful to communities for crisis care.
Typical 1–2 session consultation does not offer
longitudinal perspective to understand complicated cases.
Timely communication with referring clinician is crucial.
PCP may not have resources to implement telepsychiatrist's
Providing crisis care can be challenging for the provider.
Useful for crisis care.
Best to implement routine telepsychiatry services before implementing
Most common outpatient telepsychiatry model.
Ongoing direct care
Most consistent with in-person model of care.
Offers most expert care and greatest privacy.
Most helpful to PCPs and patients.
If limited number of telepsychiatrist hours per month
are available, this model may not be able to provide adequate frequency
of follow-up or will preclude services to the maximum number of youth.
Potential for suboptimal communication with referring PCP.
Ongoing outpatient care; correctional care.
Must decide whether initial session will occur through telepsychiatrist
or in person and who will prescribe medication.
Need procedure for interim care.
Pharmacotherapy is most requested telepsychiatry service.
Collaboration with a midlevel professional (e.g., nurse
practitioner or physician assistant)
Midlevel professional can provide continuity of care,
including crises and medications; optimizes communication between
Opportunity for midlevel professional to obtain supervision.
May only be available at mental health centers although
could be addressed during contracting.
Could be more expensive for agency.
In some rural areas, families do not want to include a member
of the community in mental health sessions.
Patients in a system of mental health care, especially
mental health centers.
Comprehensive telemental health (direct clinical services
and wraparound services)
Child receives spectrum of services from multiple providers.
Care can all be provided at provider site or by combination
of services at the provider and patient sites.
Offers opportunity to integrate telepsychiatry into a youth's
system of care.
Families and/or other clinicians and administrators
at the patient site may find this model too alien if all services are
offered through the provider site.
Sometimes difficult to find personnel at patient site to collaborate
in such models.
Youth with psychiatric disorders that impact their
functioning across multiple domains.
Telepsychiatry offers neutral mediation and guidance
to a system struggling to meet youth's needs.
Some communities may not like an "outsider" intervening
in systems issues, especially when the outsider is intervening virtually,
Schools are major utilizers, but this model also is
helpful to agencies such as foster care and juvenile justice.