Telemental Health Care for Children and Adolescents: Fulfilling a Promise

For more than a century, technology for distance communication has been imagined as a means to reduce barriers to accessing healthcare services, particularly for families in underserved communities. The idea that mental health services could also be provided via distance technology—telemental health care—arose nearly simultaneously, and in fact, the first telemedicine program of any kind to be published was a psychiatric program developed at the University of Nebraska in 1959. Despite the early enthusiasm for telemedicine, interest in developing the concept has waxed and waned through the decades, influenced by changes in the technology as well as the attitudes of providers and the public toward those changes. During the twentieth century, programs came and went, and telehealth did not fulfill its promise to conquer the barriers that limit access to care for underserved communities. Only very recently has telemental health begun to show a glimmer of a possibility that it might meet, on a grander scale, mental health needs that have not been met by in-person services. In this chapter we briefly review the history of telemental health care, discuss initial research findings, and consider the early hopes for and challenges of providing telehealth services. We then consider recent changes in the utilization of telemental health and discuss ethical issues particular to providing psychological services at a distance, setting the stage for the following chapters, which review child and family interventions that have been successfully implemented through remote technological means.