Before the pandemic, 9-year-old Landon Whitewood had a packed schedule that included Cub Scouts, swimming lessons, karate and hanging out with friends. Adopted from the foster care system as a toddler, his mothers Deb and Susan Whitewood of South Fayette have also prioritized time for trauma therapy through Three Rivers Adoption Council. He also participates in family-focused therapy and art therapy through Wesley Family Services three days a week.
When Pittsburgh began to shut down as it faced the COVID-19 pandemic in mid-March, all of these activities ceased for the Whitewood family — except for therapy. They knew that it would be absolutely essential to have access to mental health services during an international crisis.
On March 15, the Pennsylvania Office of Mental Health and Substance Abuse Services issued a memorandum urging all practitioners to switch to telehealth video appointments when possible. The office loosened requirements on HIPAA-compliant software, authorized telephone sessions where technology is not available and waived the requirement of periodic face-to-face sessions when using telehealth.
Landon’s parents reduced the number of hours of therapy per week to just two hours, delivered via telehealth.“When he’s not in crisis, he is receptive to the video. His attention span is really short, and so they work hard to engage him. It is much easier to take cues from a real person,” his mother Deb said.
Prior to the pandemic, telehealth was more common for adult patients, as therapy with children and adolescents is often play-based and interactive. Telehealth sessions due to social distancing have come with a learning curve for both families and practitioners.
A 2013 review study conducted by the Telemedicine Journal and E-health found virtual sessions to be effective across multiple settings for individuals spanning from children to geriatric patients, and improve access to care amid mitigating circumstances. A 2018 study through the University of Michigan School of Public Health corroborated these findings and noted that the majority of participants felt telehealth was vital to to continuity of care. In the past, many telehealth services weren’t covered by insurance — COVID-19 has removed that barrier.
Kori Shearer is a licensed professional counselor [LPC] with the Psychology and Learning Center in Monaca in Beaver County. She sees clients from a variety of backgrounds but specializes in teens with depression and anxiety, suicidal or self-injurious behavior, as well as LGBTQIA-related issues.
Shearer was worried at first about the ability to shift to virtual sessions, particularly for her younger clients. She has noticed, though, that these younger clients have been excited to show her their space — often their bedrooms. It has been useful for Shearer to see them in their home environments. “I give the child a choice to have their parent leave the room or remain for the session, and we bring the parent back in if needed,” she said. “This has always worked for my face-to-face sessions and it has worked well for telehealth, too.”
Shearer recommends parents and practitioners maintain as much normalcy and structure as possible for the sessions.
Similarly to Landon, 6-year-old Patton Manion of Mt. Lebanon had a packed social schedule prior to the onset of the pandemic. Routine and predictability are important to him, and the sudden loss of his school and familiar safe spaces hit him hard. His parents, Kara and Patrick Manion, are both public school teachers and are teaching remotely while also parenting Patton and his 3-year-old brother, Marlow. They knew that continuing his weekly therapy through the Center for Pediatric Neuropsychology in Mt. Lebanon would be key to managing this stressful transition. His therapist has been able to coach his parents remotely on how to help him manage the anxiety.
The pandemic reinforces the feeling for Patton that leaving the house is stressful or bad, his mother said, even if it’s for something he wants to do. His therapist is working on activities that teach him to manage emotions, matching the size of the reaction to the “size of the problem.” His parents give him tasks that he doesn’t prefer to do, such as chores, to help him work through the emotions around being asked to do something that is not his preference.
Stephanie Azarcon is a licensed clinical social worker for the Child and Family Counseling Center of Children’s Hospital of Pittsburgh UPMC. Like Shearer, she had not been using telehealth prior to the pandemic. Her clients range from ages 3 to 22, and much of her work with younger children is Parent Child Interaction Therapy. This type of therapy is usually done with Azarcon coaching parents through a double-sided mirror as they interact with their child.
A virtual platform is a huge shift, but she has found the process to be effective over the last two months. She encourages parents to help set their child up for a productive session. They should review and prepare for the therapy session such as they would do on the car ride to the therapy appointment. They can discuss with their child what they want to get out of the session.
“Try to talk with them beforehand to explain the expectations of a virtual/video therapy session,” Azarcon said. “The more confined, the more focused they will be. You can still sit them on a yoga ball or let them fidget with things while doing therapy.”
Both Shearer and Azarcon are unsure if the state will continue to allow such flexibility to use remote services once life shifts back toward “normal,” but they both have seen a benefit in learning how to treat children remotely. Azarcon has been able to see behaviors occur in the home setting that she would not see in her office, such as conflict between siblings or oppositional and defiant behaviors. She is able to offer support to the parents in the moment instead of at a later time when discussing at the office.
Shearer added that she has had fewer missed sessions since she has been able to use telehealth. “At this point, insurance companies are covering services with the contingency that it lasts during the pandemic, so we may not be able to provide it with the same degree of availability for a bit,” Shearer said. “I think it would be fantastic to be able to provide both.”
Deb Whitewood also feels that the continuation of virtual sessions could be beneficial. It provides a way to maintain consistency even when life becomes unpredictable and serves as one more useful tool her son can have in his repertoire. “Would it be more helpful to have sessions in person? Yes,” Deb said. “But exposing him to telehealth at this stage is good; he will always have it in his backpack, so to speak.”
Meg St-Esprit is a freelance journalist based in Bellevue. She can be reached at megstesprit@gmail.com or on Twitter @MegStEsprit.
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