Estudio cualitativo
Published on 21 de marzo de 2024 | http://doi.org/10.5867/medwave.2024.02.2777
Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study
| History of mental telehealth | Resources needed for its implementation | Lack of training in mental telehealth Lack of research in mental telehealth Need for guidelines to implement mental telehealth | I work with child confidentiality, so when the parents come in with me, I tell them that I am not going to tell them what the child says since he is my patient, so I don't tell them [SIC] what they say, although I share impressions and everything, it is never like this: 'Look, he said this', so now I have a hard time telling them: 'I want to talk to Juanito or X, is it possible to leave him in a room with the cell phone alone for a while?' Focus Group 2 (Psychosocial team). Code: Ethical questions |
| Preconceptions | Initial pessimism regarding mental telehealth Is mental telehealth psychotherapy? Ethical issues | ||
| Implementation of mental telehealth | Changes in the setting | Increased participation of caregivers Ensure the privacy of the session is protected Need for support elements (stories, figures) Variability in the hours of care Variability in the attention schedules Presenteeism Greater sense of availability of the therapist for users Longing to physically see the therapist | "With young children in the hospital, I think I would prefer, if there is a choice, I would prefer the traditional approach of seeing each other in person and having the playing space that I think is very important, and that is the biggest challenge I have found in this virtual space, as that transitional space, I think I don't know if... I think it is also a topic to investigate how that transitional space is built in virtuality" Focus Group 2 (Psychosocial team). Code: Need for support elements |
| Differences between video calls and phone calls | Video calls last longer than phone calls Phone calls lose non-verbal cues Greater user comfort on phone calls without the other’s gaze Greater user honesty in phone calls Possibility of user deceiving by the telephone | ||
| Mental telehealth from the therapist’s perspective | Mental health risk for the therapist | Loss of boundaries between work and personal life Use of own resources (such as telephone number) Lax schedules Feeling of increased physical and mental fatigue Feeling that work encroaches on home and vice versa Therapists are also experiencing a pandemic | I have had to supervise myself more than in other opportunities and value teamwork more in circumstances of an institution such as the hospital because I need to be connected with others. Focus Group 2 (Psychosocial team) Code: Feeling of greater physical and mental fatigue |
| Emergence of new resources | Emergence of new resources Learning the use of communication technologies Adapting to remote care and user needs Possibility of group services Less absences Greater confidence in teamwork and intersectoral coordination Greater receptiveness of parents Facilities for users in terms of economic resources and time Knowing the user’s environment through phone and video calls. | ||
| Mental telehealth projections | Technical and administrative challenges | Need to adapt to the use of technologies Improve coordination of care Users are more easily able to refuse care (they disconnect or hang up) Users without access to ICTs A paradigm shift is anticipated: permanent incorporation of mental telehealth | "Not seeing them, not having a face-to-face encounter detracts a lot from the quality of the encounter with the other, and in our ability to get to know them, to incorporate information from the non-verbal, from the visual and also in the containment, that is, I believe that nothing can replace a hug, or that someone sits next to you and can display a look of compassion or affection" Focus Group 1 (Psychiatrists) Code: Loss of the magic of the face-to-face encounter. |
| Clinical challenges for mental telehealth | Loss of the "face-to-face magic" Nonverbal elements are difficult to assess Concern about therapeutic bonding Difficulty in performing emotional support Worsening global mental health in pandemics | ||
| Perfil de pacientes complejos para atender en telesalud mental | Specific disorders Borderline personality disorder Substance Use Disorder Intellectual Disability with Communication Disorders Severe Attention Deficit Hyperactivity Disorder (ADHD) Negativistic Defiant Disorder Severe Social Anxiety Disorder (fear of the camera) Lower educational level Dysfunctional families |
ICTs, information and communication technologies.
Source: Prepared by the authors.