Psychology, Psychiatry Patients at Cook Children’s Continue to Keep Important Appointments During Pandemic Through Virtual Visits

By Ashley Parrott

Widespread change due to the COVID-19 pandemic has swept the nation, which has left many parents struggling to keep essential appointments with, not only their physicians, but with behavioral health specialists as well. Parents are now questioning the safety of the world beyond their windows and this has led parents, as well as psychologists and psychiatrists, to the use of telemedicine.

While Cook Children’s launched the telemedicine program in 2004 before the pandemic gripped the United States, this unprecedented time has pushed the world to embrace telemedicine like never before. While many parents and behavioral health specialists opted to continue in-person visits, parents like Patti Stephens persistently waited for the opportunity.

“Even before the pandemic began, I had hoped to be able to utilize telemedicine when we moved in October 2018. I knew this move would be temporary, so I wanted the continuity of care,” Patti said. “Unfortunately, we didn't qualify for telemedicine services for psychiatry so I drove to Fort Worth for appointments or for behavioral therapy.”

Patti’s family of four children has made countless trips from their home in West Texas to various Cook Children’s locations since 2002, from one child in the NICU to annual well-child visits to family therapy visits. When Patti’s family was finally able to begin using telemedicine, it allowed their family extra time, both in commuting and rounding up all four children at times for one appointment. With telemedicine, Stephens said her children found comfort in being in their own environment and she found flexibility in being able to schedule an appointment whenever she needed.

When the pandemic made it to Texas, Cook Children’s physicians quickly realized telemedicine would need to move to the forefront of their care delivery. Similar to some parents, physicians had to adapt quickly and learn how to use this technology in a way that would benefit each patient.

“When I heard we were going to utilize telehealth, my initial concern was my lack of experience and confidence in using this approach. I became anxious about how to meet the needs of my families best,” Laura Wright, LPC-S Family Therapist, said. “Therapeutic relationship is foundational for therapy, and I was concerned that would be lost in translation using telehealth. I wondered if my patients would be able to focus and attend to sessions in their home settings with all of the potential distractions.”

Concerns around telemedicine faded as patients began to flourish in the comfort of their homes. Parents and physicians may have experienced a learning curve; however, young patients took to the new technology quickly.

“I found rapport to be better unexpectedly. Patients would excitedly show their room or pets, and I felt I knew them better,” Hari Kumarasen, M.D., a psychiatrist at Cook Children’s, said. “It gave me insights into the patient’s personality. Telehealth allowed me to make observations about the child, seeing them in their environment, which I wouldn’t have otherwise been able to make. I also found my anxious and scared children and teen patients are more chill in their own environment.”

Telemedicine allows for long-distance patient/physician relationships, and offers parents options for non-emergent questions if a patient is traveling or not able to make an office visit.

“I have long felt that teletherapy should be an option for both patients and therapists. Especially for parents who have multiple children in therapy. It is so much easier to make and keep appointments via telemedicine,” Patti said. “Also, if we have established a relationship with a particular provider and either the provider or family moves further away, we don't have to start over with building a relationship with someone new.”

When the world begins to feel relief from COVID-19, patients and physicians alike are hoping to incorporate telemedicine into their routines. The ease of access for healthcare has created a positive outcome from an outbreak that has affected society so negatively.

“This is something I would absolutely desire to continue using, if not solely, at least in part. The lack of a stressful commute has been beneficial to my well-being, sparking newfound enthusiasm and creativity in my work,” Stephanie Golden, LPC Family Therapist, said. “As for a majority of my clients, participating in a familiar, safe setting called “home” seems to facilitate a willingness to engage more readily and thoroughly.”

At the beginning of the COVID-19, insurance covered telehealth appointments because patients could not keep their appointments in person. As the pandemic continues, more providers are returning to pre-COVID payment methods, meaning more companies are asking people to pay out-of- pocket for virtual visits. That leaves those who have benefitted from the telehealth concerned that it will go away or become costly for patient families who need it most.

“I am very concerned that we will lose the ability to conduct telehealth services due to insurance coverage limitations. It has proven to be beneficial for many of our patients, especially during this time of a global health crisis with the highly-contagious pandemic,” Golden said. “It certainly is advantageous for parents, giving some peace of mind about keeping their children in a safe space, removing the burden of taking their children away from the classroom and critical learning, and easing the stress of transporting them to and from the counseling office setting.”

The introduction of telemedicine has given families more access to health care focused on the patient experience and allows us to reach a child no matter where they are in the state of Texas. Physicians and health care providers’ willingness to adapt during the pandemic has raised the bar for healthcare delivery systems.

“Several of my patients and parents have shared the hope that telehealth will continue to be offered/available, noting the convenience of the service,” Wright said. “Distance for our remote families, lack of transportation, multiple children’s schedules to juggle, school, commuting, and work are all barriers to mental health treatment. Telehealth breaks down those barriers to reach these families.”