Online Therapy for Kids & Teens
Telehealth can be a very effective form of service delivery in prevention and psychoeducation, assessment, counselling and treatment of children and young people. It is, however, considered to be less effective with very young children and you may find that psychoeducation telehealth sessions with parents and teachers are more appropriate for this age group.
If the technology is well set-up, telehealth generally allows for the same observations as face-to-face observation. Therapists can observe subtle non-verbal communication, facial expressions and body language on the screen. With younger children it is possible to observe parent/child interactions in the home to help inform therapy.
Telehealth can be used successfully with children experiencing stress, anxiety, relationship difficulties and grief and loss. Interactive whiteboards on digital platforms allow children
and young people to do the same sort of drawing exercises and treatment activities as in face-to-face sessions.
Social-skills programs, specific groups (e.g., for gifted students, assertiveness training) and other group work can be delivered using many teleconferencing programs. Digital interactive materials (e.g., videos, therapy activities), rapport-building exercises, icebreakers and worksheets can also be employed.
Telehealth also allows for extensive use of creative and play-based techniques. During consultations, children can complete drawings and use other media to express themselves. Encourage them to talk while they are drawing. Stories can be read and breathing exercises modelled to help children with relaxation and mood regulation.
Engaging children with telehealth
Children generally enjoy participating in telehealth sessions from the comfort of their own home. Technology devices are often more familiar modes of communication to children than to therapists and telehealth can be less confronting for a child compared to an unfamiliar therapist’s office.
Trust and confidence can be built if the session is well set-up and the technical quality of the session is optimal. It is important, for example, that children clearly understand what is required of them in the session. It is important that it is an authentic interaction where the child feels that the therapist is listening closely and are not distracted by interruptions. It is important that the light is good and that facial expressions can be clearly seen. High-quality audio is critical to success and it is important that there is no audio lag. It is also important for engagement that there is a clear line of sight at eye level from therapist to the child.
In the first telehealth session with a child or young person it might be useful to provide a short and age-appropriate explanation of why they are participating in an online session, particularly if they are used to face-to-face sessions. Early sessions can be dedicated to explanations and practice using the new technology, as well as addressing any anxiety that the child might have about COVID-19 along with exploring the broader issues for which the child is presenting.
In the first few sessions, children can be shown how to draw on the whiteboard, share their screen and play online games. This will help the therapist build rapport and engagement as well as offer opportunities for you to describe how the sessions will unfold.
It is important to note that young children may have difficulty engaging appropriately with a therapist online. They can be distracted by their own image on the screen and this becomes the focus of their attention. Young children may be more inclined to wander away from the computer because they are in the comfort of their own home. This is less of a problem for children of mid-primary school age, but therapists should develop a toolbox of online games and activities to keep children engaged.
There can also be difficulties engaging children online if they are in a room with distractions, for example, a television or if they are at the kitchen table. This needs to be discussed with the parent before the first session. Equally it can be distracting for the child if the therapist is in a room with any visual or auditory distractions or clutter.
The amount of time a parent is part of a session, or in the room with a child is more difficult to control with telehealth. This needs to be agreed to with the parent prior to a session and included in the informed consent documents. Therapists also offer shorter sessions for children who are at risk of disengaging from the online process.
A test run of an online session with a parent or child is advisable. To help address any technical problems parents can also be encouraged to log on to their computers 10–15 minutes before scheduled appointment times so the inevitable set-up issues do not encroach too much on the session time available.
Engaging adolescents with telehealth
As with young children, adolescents may also need reassurance that this new model of practice is an interim solution to an unusual and worrying situation. It may be that anxiety about COVID-19 is part of the presenting problem for the young person. However, adolescents often prefer telehealth over face-to-face sessions with a therapist especially in the school setting. They might feel more positive about the privacy of telehealth and knowing that their peers don’t know they are seeing a therapist. Telehealth also allows for greater flexibility and may result in increased time available between young people and their therapists.
Young people might become more engaged in the telehealth experience if they are encouraged to use the more sophisticated features of the platforms, such as discovering the interactive tools, creating their own visual backgrounds and using the chat or text options. These tools can be useful adjuncts for treatment programs, for example, for setting and monitoring goals and objectives for learning or behaviour change for a young person.
With adolescents it is important to set clear parameters about what is acceptable and what is not acceptable in a telehealth session. Online interactions are often the preferred mode of communication between young people and they generally experience very relaxed interactions with their peers. They might assume this informality applies to the therapist session as well. To counter this possibility, clear expectations need to be established about such issues, for example:
- Recording of sessions: Request that sessions are not recorded
- Mobile phones: Request that mobile phones are turned off and are not accessible
- Privacy: Think about who else can potentially overhear the conversation. Who else will be in the room? Who is in the room next door?
- Where is the young person sitting? Is it ok for them to be in their bedroom? A more neutral setting may enhance the professional focus of the session.
- Parents: What is the involvement of family members?
- Levels of informality or propriety: Is it appropriate for the young person to be in their pyjamas?
- Background distractions: What are acceptable visual and noise backgrounds, for example, can the young person play music?
- Communication with the therapist: What are the processes for contacting you outside of scheduled sessions?
- Risk management: What are the safety plans if, for example, the young person fails to log on and can’t be contacted?
Involvement of parents
Communication with parents is essential to the success of telehealth. Strategies to ensure that parents can support their children might include preparing them for the service by providing a telehealth introduction kit which advises them, before the first session, how the counselling or therapy will proceed and what they should expect. The kit could include:
- information about the benefits and limitations of telehealth
- information about the parent’s involvement and whether the parent is part of the session or in the room
- instructions about using the digital platform, including arrangements for a practice session to get used to the technology (if possible)
- suggestions about ways in which the home device can be setup for maximum success (e.g., lighting, privacy, background noise, minimising interruptions)
- suggestions for what a child might need to have in front of them for a telehealth session, for example, coloured pencils, paper, favourite toy, favourite story to use as an icebreaker, any charts or reinforcement schedules that may be part of an intervention
- a telehealth consent form and privacy statement
- a form for emergency contact details
- clear advice as to when a telehealth session should be converted to a face-to-face session
- details about how the psychologist can be contacted between sessions, and
- advice about what to do if the session is disrupted by technical faults.
If you think your child or adolescent could benefit from online sessions, please contact Therapy in Barcelona and we will help you take the next steps.
This information is from the Tip Sheet from
The Australian Psychological Society Limited www.psychology.org.au
The information is current as at 2 April 2020.
