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
| Implementation of mental telehealth | Communication media used | Video and phone calls - Phone calls only - Messaging services | Interviewer: Hey, and at this time, when you attended via telephone, tell me a little bit about that; what space were you in? What was it like? Patient: I am in a space by myself because my parents gave me my space so I could talk better; that’s it. Adolescent 16 years old, female. Codes: A respectful family environment allows privacy. |
| Care conditioning factors | Not having a camera or not knowing how to use it Caregiver does not know how to use the communication platforms - Positive assessment of seeing the therapist’s face in the video call - Respectful family environment allows for privacy | ||
| Evaluation of mental telehealth users | Satisfaction with remote care | A safe environment is generated - It is possible to talk comfortably - Relief and respite are found. - The professional’s concern is perceived - Trust in the therapist can be maintained A respectful family environment allows for privacy | "It has been like psychotherapy, so to speak. Being able to talk to people I trust that they are not going to tell anyone else has been a good way to let off steam, not the best way, but yes, it has been a good way". Adolescent 16 years old, female. Codes: Trust in the therapist can be maintained, Relief and respite can be found "Because I feel that regardless of whether the help is there, whether in person or not, the help will continue to be there and it depends on each person whether to take it or not and in my case, I would take it blindly because the help of a psychiatrist is not something I go through every week" Adolescent, 16 years old, male. Code: The act of help is perceived at a distance. "I feel that face-to-face care is a super close contact between the patient and the specialist, so I feel that being face to face is super important because if it were not so, the specialist and the patient could not have the same connection and the same trust as over the phone" Adolescent, 16 years old, male. Codes: The same intimacy is not achieved, Lack of "face-to-face" contact, Face-to-face consultations provide a climate of greater closeness and trust. |
| Conformity and resignation with remote services | Satisfaction with the duration of care Satisfaction with care | ||
| Disapproval of remote care | Lack of "face-to-face" contact - Going to the hospital and talking in person is perceived as a therapeutic act Higher expectation of care | ||
| Elements not considered for preferring remote care | Transfer to the hospital (e.g., lives nearby) No worries about getting infected - Scheduling and timetable | ||
| Similarities between the two care modalities | The user feels understood Therapeutic bonding is achieved - The act of help is perceived from a distance Pharmacological indications are understood Characteristics of the therapist and not the modality of care are what determine the level of intimacy | ||
| Advantages of remote care | Being able to choose the place of care (bed, room) - Not having to travel to the hospital For caregivers to maintain the care of other children Greater communication between caregivers and professionals Feeling of greater availability of the therapist in remote care Prevention of COVID-19 contagion | ||
| Differences and disadvantages of mental telehealth compared to face-to-face care | Face-to-face sessions last longer - Face-to-face sessions allow and encourage play as a clinical tool Face-to-face sessions are more spontaneous - Face-to-face sessions provide a climate of greater intimacy and trust The same intimacy is not achieved - More time is required to trust the therapist The therapist takes more time to respond to your needs Contact is initiated without prior notice | ||
| Projections | Current preferences | No preference between face-to-face and remote Prefer face-to-face services Prefer telephone services Accept the remote as temporary | Why I don't like video calls, I mean, it’s not that I don't like them ... I don't like, for example, showing my face all the time here, no more calls. 15-year-old male adolescent. Code: Prefers telephone attention. "It would be convenient because that way we would have... that is, for the girl to come and talk on the phone, it would be convenient to have both, in person and by phone; it would also be good". Mother of a girl under 12 years old. Code: Prefers mixed care "No, because it hasn't helped the child because he gets the same as he did with you...as he is now, he doesn't want to talk on the phone, they ask him questions, and he says he doesn't know, he gets angry and starts crying, very similar to what he did now" Mother of a child under 12 years old with cognitive difficulties. Code: Prefers face-to-face care, Young and/or restless children. |
| Preferences without Pandemic | Prefer face-to-face service Prefer mixed service | ||
| Challenges | Interference and distraction by the environment Achieving privacy Mistrust of talking to someone without knowing them in person | ||
| Complex patient profile for mental telehealth care | Young and/or restless children Serious patients Patients with occupational therapy indication | ||
| Problems in the use of ICTs | Poor phone or internet signal Lack of knowledge of the use of ICTs Higher expenditure on ICTs (e.g., internet plan) |
ICTs, Information and communication technologies.
Source: Prepared by the authors based on the study results.