NYU Langone’s Department of Child and Adolescent Psychiatry has long been a leader in providing telepsychiatry to young patients and in research, education, and advocacy aimed at advancing the use of this modality to bring mental healthcare to underserved populations. The coronavirus disease (COVID-19) pandemic has accelerated these efforts on every level.
Laying the Groundwork
For more than a decade, NYU Langone has partnered with the New York State Office of Mental Health (OMH) to provide telepsychiatry services to several psychiatric facilities in rural upstate communities. The Department of Child and Adolescent Psychiatry also established a training clinic in pediatric telepsychiatry for NYU Langone residents and NYU Grossman School of Medicine students in partnership with the Rockland Children’s Psychiatric Center, an OMH-run institution in Orangeburg, New York. While preparing future practitioners, this clinic offers remote mental healthcare via school-based programs in Ulster and Sullivan Counties.
In 2017 Shabana Khan, MD, assistant professor of child and adolescent psychiatry and director of child and adolescent telepsychiatry, joined the faculty of the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, to promote the expansion of such services in the New York City area and beyond. Partnering with NYU Langone Hospital—Brooklyn, the center launched telepsychiatry programs at two public schools in the largely low-income Sunset Park neighborhood, with the goal of reaching school-based mental health programs throughout the borough.
In addition, Dr. Khan collaborated with Sandra M. De Jong, MD, assistant professor of psychiatry at Harvard Medical School, and the American Academy of Child and Adolescent Psychiatry (AACAP) Telepsychiatry Committee to develop a nationally accessible online pediatric telepsychiatry curriculum for use by child psychiatry fellows, fellowship program directors, and faculty.
Since arriving at NYU Langone, Dr. Khan—who is co-chair of the AACAP Telepsychiatry Committee—has contributed to many efforts to inform state and federal policy, ranging from White House conferences on Centers for Medicare and Medicaid telemedicine coverage to discussions with Drug Enforcement Agency officials on regulations governing telemedicine prescribing of controlled substances.
Responding to the Crisis
When COVID-19 caseloads began mounting in March 2020, telepsychiatry’s potential to solve a new problem—providing mental healthcare without exposing patients or providers to the risk of contagion—quickly became apparent. Before the pandemic, legal, regulatory, and reimbursement hurdles often limited the legitimate practice of telemedicine. The rapidly rising rates of COVID-19 across the United States served as an impetus for flexibilities related to telehealth at the federal and state levels.
The Department of Child and Adolescent Psychiatry was well positioned to take advantage of these changes. “Because we had that technology infrastructure and training already in place, we were able to rapidly transition to remote care throughout the NYU Langone Health network and at other sites where our faculty members practice,” Dr. Khan explains.
From the Child Study Center outpatient practice to the upstate programs, most on-site visits were converted to telepsychiatry sessions conducted via smartphone, tablet, personal computer, or landline wherever both parties could access a connection. (Many college students, forced to return to their parents’ homes out of state, were thus able to receive uninterrupted care.) NYC Health + Hospitals/Bellevue Child and Adolescent Psychiatry Clinic, which had not previously offered telepsychiatry, made the switch seamlessly under the leadership of director Alan D. Schlechter, MD, clinical associate professor of child and adolescent psychiatry.
A Massive Expansion in School-Based Telepsychiatry Services
Perhaps the most extensive transformation took place in the school-based programs overseen by Aaron O. Reliford, MD, clinical assistant professor of child and adolescent psychiatry, director of child and adolescent psychiatry at NYU Langone Hospital—Brooklyn, and associate medical director of the Behavioral Health Program—Family Health Centers at NYU Langone. As New York schools shifted to online-only classes, Dr. Reliford and the leadership team at the Sunset Terrace Family Health Center at NYU Langone succeeded in expanding telepsychiatry services from the original 2 sites to all 20 Brooklyn schools whose clinics are affiliated with the Family Health Centers at NYU Langone. All patient visits handled by these clinics would now be conducted remotely.
The transition entailed significant challenges, such as ensuring that families had appropriate Wi-Fi connectivity and devices to conduct the video visits, being creative in conducting play therapy sessions with younger children, and finding space in cramped apartments for patients to speak privately with therapists. “We were able to work through such issues with the strength of our clinicians and the alliances we forged with parents,” Dr. Reliford says, “and the results were amazing.” Patient volume soared and remained elevated even over summer vacation, when engagement typically dips. Meanwhile, show rates improved to more than 75 percent.
“Telepsychiatry has enabled us to serve more students during the pandemic than we’d done previously,” Dr. Reliford notes. “And connecting with children in their homes has allowed us to engage more children and families, with comparable quality of care.”
Carrying the Pandemic’s Lessons into the Future
Overall, the Department of Child and Adolescent Psychiatry has seen a more than 10-fold rise in telepsychiatry visits over the past year, from approximately 2,400 in fiscal 2019 to more than 30,000 in fiscal 2020—an increase almost entirely attributable to COVID-19. In the process, thousands of children and their parents have discovered that telepsychiatry offers advantages beyond those associated with the pandemic. “The feedback we’re hearing is overwhelmingly positive,” says Dr. Khan. “Patients and their families are thrilled with the convenience and accessibility. They’re getting the same expert care they would normally receive, without having to leave home.”
Members of the department are taking steps to ensure that widened access to telepsychiatry persists beyond the pandemic and that lessons learned during the crisis are incorporated into public policy and day-to-day care. Dr. Khan, for example, is helping AACAP and the American Psychiatric Association develop state and federal legislation that would permanently extend COVID-19–inspired flexibilities in coverage. She is also working with AACAP to update best-practices guidelines for pediatric telepsychiatry and is leading NYU Grossman School of Medicine’s Telemedicine Task Force to build a telehealth curriculum for medical students. Dr. Reliford recently submitted a proposal to OMH that would enable NYU Langone to continue providing school-based telepsychiatry services to patients’ homes after the crisis recedes.
“Research has shown for years that telepsychiatry produces very high satisfaction rates among both patients and clinicians and outcomes comparable to in-person care, but one of the biggest challenges was getting clinicians and patients to try it,” Dr. Khan observes. “Now that the pandemic has given them that opportunity, I believe there’s no going back.”