Bridging Care Gaps: Using Tele-health to Provide Care for People With Autism Spectrum Disorder.

OBJECTIVES: Explore the usage of telehealth to conduct diagnostic assessments and interventions for people with Autism Spectrum Disorder. METHODS: A Pubmed search was conducted using the words telehealth, telemedicine, video conferencing and telepyschiatry in conjunction with the words Autism Spectrum Disorder, Autism, Asperger's, and Developmental Disabilities. Personal experience from the first author, a telehealth and ASD expert, was also utilized. RESULTS: While telehealth usage and satisfaction are high, its utility in the diagnosis of Autism Spectrum Disorder is limited. There are few studies to support the validity of the ADOS and ADI, gold standard diagnostic tools, when administered via videoconferencing. CONCLUSION: Telehealth with high quality videoconferencing to provide health care, is an excellent venue to see patients with ASD that live far from experts. Its suitability as the venue for diagnostic assessment is acutely limited. It is a useful tool to triage and engage patients and families, an effective venue to provide education and training for caregivers, healthcare providers and other professionals and an effective modality to provide symptom management.

Developing Rapport and Therapeutic Alliance During Telemental Health Sessions with Children and Adolescents.

OBJECTIVE: The purpose of this study was to describe the special considerations for building rapport and establishing a therapeutic alliance when conducting mental health evaluations for children and adolescents via videoconferencing. METHODS: The authors review the literature and describe their experience in conducting mental health evaluations, developing rapport, and establishing a therapeutic alliance during telemental health practice. RESULTS: Clinical need and shortages of clinicians with expertise in evaluating mental conditions for children and adolescents in underserved communities have stimulated the rapid expansion of telemental health programs while the research base continues to develop. The emerging evidence base and clinical experience suggest that teleclinicians can, and do, build rapport and establish a therapeutic alliance during telemental health sessions with youth and families. Families may be more accepting of telemental health approaches than clinicians. The impact that technology, equipment, site staff, community supports, cultural identification, and teleclinicians' characteristics have on building rapport and establishing a therapeutic alliance should be considered when establishing a telemental health service. Staff at the patient site and referring providers have a valuable role in supporting the therapeutic alliance between telemental health providers and their patients, and ultimately supporting the success of a telemental health program. CONCLUSIONS: Teleclinicians are creative in transcending the videoconferencing technology to evaluate patients using guideline-based care. Further research is needed to determine how clinicians build rapport and establish a therapeutic alliance during telemental health sessions, and whether the therapeutic alliance is associated with the accuracy of evaluation and outcomes.