ABSTRACT

Objectives: This study explored a new telehealth educational and development psychologist (EDP) service 10 provided as part of a multidisciplinary team to rural families. We aimed: 1) to examine the role and process changes made in telehealth consults compared to in-person consults, and 2) to evaluate the satisfaction of key stakeholders with the telehealth service.

Method: We used an exploratory qualitative case study design involving care observations, semi-structured interviews and satisfaction surveys. Participants were i) one EDP, four multidisciplinary team (MDT) members and six service managers 15 employed by BUSHkids, a not-for-profit health service in Queensland, Australia; and ii) 23 parents of 20 children enrolled in the service.

Results: Telepsychology involved major additions to in-person roles and processes, including the creation of a telehealth facilitator role. Key role and process changes were identified: 1) extending MDT roles to assist the EDP with clinical data collection and extending parent roles to act as co-therapists; 2) increased clinician processes focused around maintaining 20 therapeutic presence through verbal interaction strategies and creating shared virtual spaces; and 3) increased routines and documentation demonstrated in extra EDP preparation time, additional technology sub-routines, and more correspondence between team members. Service satisfaction was rated as moderate-high by the EDP, MDT, and parents.

Conclusions: Telepsychology, while requiring significant practice change, was an acceptable way to delivery educational and developmental psychology services.

Key Points

What is already known about this topic:

1. Emerging evidences suggests telemental healthcare for children and adolescents is comparable to in-person services in diagnostic acuracy, attainment of clinically relevant improvement, and perceived therapeutic alliance.

2. Evidence for telehealth adoption in pediatric populations usually focuses on clinical effectiveness, rather than psychologist experience of shifting from in-person to telehealth practice.

3. Preliminary evidence suggests telehealth involves significant change in clinician roles and processes.

What this paper adds:

1. In this rural multidiscipliniary team, the adoption of an EDP telehealth service involved the addition of a new role (telehealth facilitator) as well as multidisciplinary team and facilitator role expansion involving feeding back some clinical information to the clinician, as well as parent role expansion relating to keeping children engaged in therapy.

2. Additional work processes were also observed as the psychologist used verbal comments and shared virtual spaces to established their presence at a distance, and introduced new work subroutines to prepare for telehealth consults and manage telehealth technology.

3. Role and process changes were not observed to clinician authority or disrupt core clinical roles such as triage, intake, formulation, treatment, review or discharge.

摘要

目标：本研究探索了一种新的远程医疗教育和发展心理学家 (EDP) 服务 10，该服务是作为多学科团队的一部分向农村家庭提供的。我们的目标是：1) 与面对面咨询相比，检查远程医疗咨询的作用和流程变化，以及 2) 评估关键利益相关者对远程医疗服务的满意度。

方法：我们使用了探索性的定性案例研究设计，包括护理观察、半结构化访谈和满意度调查。参与者是 i) 一名 EDP、四名多学科团队 (MDT) 成员和六名服务经理 15 受雇于澳大利亚昆士兰州的非营利性医疗服务机构 BUSHkids；ii) 20 名儿童的 23 名家长参加了该服务。

结果：远程心理学涉及对面对面角色和流程的主要补充，包括创建远程医疗促进者角色。确定了关键角色和流程变化：1) 扩展 MDT 角色以协助 EDP 收集临床数据并扩展家长角色以充当联合治疗师；2) 增加的临床医生流程侧重于通过口头互动策略和创建共享虚拟空间来维持 20 个治疗存在；3) 在额外的 EDP 准备时间、额外的技术子程序以及团队成员之间更多的通信中展示了更多的程序和文档。服务满意度被 EDP、MDT 和家长评为中高。

结论：远程心理学虽然需要显着的实践改变，但却是一种可以接受的提供教育和发展心理学服务的方式。

关键点

关于此主题的已知信息：

1. 新出现的证据表明，儿童和青少年的远程医疗保健在诊断准确性、临床相关改进的实现和感知的治疗联盟方面可与面对面的服务相媲美。

2. 在儿科人群中采用远程医疗的证据通常侧重于临床有效性，而不是心理学家从面对面转向远程医疗实践的经验。

3. 初步证据表明，远程医疗涉及临床医生角色和流程的重大变化。

本文补充的内容：

1. 在这个农村多学科团队中，采用 EDP 远程医疗服务涉及增加一个新角色（远程医疗协调员）以及多学科团队和协调员角色扩展，包括向临床医生反馈一些临床信息，以及与父母相关的角色扩展让孩子们参与治疗。

2. 还观察到其他工作流程，因为心理学家使用口头评论和共享虚拟空间来建立他们的远程存在，并引入新的工作子程序来准备远程医疗咨询和管理远程医疗技术。

3. 临床医生权威没有观察到角色和过程的变化，也没有破坏核心临床角色，如分类、摄入、配方、治疗、审查或出院。