Researchers at Columbia University are testing new ways to engage youth who rely on telehealth to treat mental health issues, including anxiety and depression, through a study funded in part by the Morgan Stanley Alliance for Children’s Mental Health.
How do you convince a teenager with major depression or anxiety to embrace therapy? What if the teen hails from a racial or ethnic minority community less likely to have equitable access to mental health treatment? Now imagine that the therapy happens only through a smartphone or computer screen. What might make the teen more likely to participate and stay engaged?
The Rise of Teletherapy
These questions are all too familiar to the psychologists, psychiatrists and other mental health professionals at Columbia University, and their partner hospital, NewYork Presbyterian-Morgan Stanley Children's Hospital (NYP-MSCH).
“We pivoted abruptly to telehealth when COVID hit," says Laura Mufson, PhD, associate director of the Division of Child & Adolescent Psychiatry in the Department of Psychiatry at Columbia University Vagelos College of Physicians and Surgeons. And while many pediatricians and other physical health specialists at NYP-MSCH have returned to seeing patients in-person, most mental healthcare providers there are continuing to provide care virtually.
Teletherapy may be more convenient than trekking into the clinic, but it also presents some challenges—especially for the Latino teens that the hospital treats, who typically come from Harlem, Washington Heights and the Bronx. When the pandemic began, many of them lacked access to the technology needed to engage in telehealth services, though Columbia has since provided some families with devices and hotspots.
Privacy can also be an issue. “The people in the community we serve sometimes don't live in homes where kids have their own bedrooms, so it's not always easy to conduct a private and confidential session," says Mufson.
Assuming a patient can carve out a private-enough space to chat and everyone's Wi-Fi is working properly, virtual therapy still tends to lack the immediacy and intimacy that comes with being in the same room with a therapist. Additionally, “in the Latino community, there's [often] a stigma around receiving mental health services and what it means to talk to someone outside the family about personal issues," says Mufson.
Forging a successful bond between practitioner and patient and engaging teens in their care in light of these circumstances can be difficult. But Dr. Mufson believes that starting the treatment with a special session that's intensely focused on combatting perceived and logistical barriers to care may make a difference.
Finding Ways to Address the Challenges
To test her theory, she is using a grant from the Morgan Stanley Alliance for Children's Mental Health to conduct a pilot study that will involve 40 children aged 12-18 and their parents or caregivers. The goal is to encourage teenaged patients to become informed and involved in decision-making about the therapy process so they're less likely to drop out before they get the help they need, despite any hurdles presented by teletherapy.
While all participants will receive care, only half will start off participating in something called Making Connections Intervention-Telehealth (MCI-T). MCI-T is an intervention based on a previous iteration, MCI, that was developed by Michael Lindsey, Ph.D., a study collaborator, with the goal of addressing perceived and logistical barriers to care among Black teens and their families so that they can access mental health care when needed. Another Columbia study collaborator, Carolina Vélez-Grau, PhD, is helping to modify this intervention to be culturally relevant to the Latino community that receives care at NYP-MSCH and to target issues around engaging in telehealth.
Researchers will randomly assign study participants to either of two groups: Participants assigned to the MCI-T arm will start their treatment with one or two sessions specifically focused on assessing the teen's readiness for change and addressing any potential logistical and psychological barriers to treatment. “The goal is to help the child and the caregiver reflect on what's happening in their life and where they want to be, and allow them to come to the realization that making some changes, including participating actively in therapy, will help them get where they want to go," says Mufson. “I've been working with this community for over 30 years, and there have always been obstacles to effectively engaging families in treatment for a variety of reasons," she adds. “Some come seeking services but we fail to keep them in treatment for reasons that include life stressors, lack of information about mental health treatment and conflicting family priorities." In order to provide a basis for comparison, those in the other arm will receive care without the MCI-T session.
Although this study is relatively small, Dr. Mufson hopes it will shed light on the benefits and challenges of telehealth for this specific population, as well as test the effectiveness of the adapted Making Connections Intervention-Telehealth model. Given the national shortage of mental health providers, and the uptick in depression and anxiety that has occurred during the pandemic, figuring out how to make telehealth work well is crucial, she adds.
“Telehealth isn't going away, even when the pandemic someday ends," says Mufson. “It's here as a model and we need to better understand how to optimize its use."
