Table 4.

Before starting.

General knowledge and experience about TMH	Clinicians should ask whether the patient (and their parents/caregiver) has even seen a physician through telemedicine (or TMH) and, if not, whether he/she has used any online videoconferencing. If the patient (and their parents/caregiver) has not seen a physician through an online videoconferencing, it could be helpful to make references to common lay technology, such as telephony, Facetime®, Skype® and so on, and explain key differences of these online videoconferencing platforms.
General notions about TMH	Clinicians could briefly provide some historical background on why TMH has been firstly used (i.e., to bring the patient specialty care without burden to the patient of travel or missing work).
Specific notions about the efficacy and effectiveness of TMH interventions	Clinicians could briefly provide some evidence-based data on studies about the application of TMH amongst adults and youngsters as well as cite some relevant data on the use of TMH intervention in specific mental disorders.
Explanation on how TMH works	Clinicians should explain to young patients (and their parents/caregiver) that the TMH session may happen in a “real time” (i.e., synchronous) or asynchronous modality; explain key differences between two modalities and when we recommend asynchronous versus synchronous modality in providing a TMH intervention.
Clarification about recording TMH session	Clinicians should inform young patients (and their parents/caregiver) whether or not a TMH session will be recorded. If a clinician desires to record a TMH session, then he/she must obtain an explicit and written consent from the adolescent patient and his/her parents/caregiver. If a clinician desires to record a TMH session, then he/she should provide motivations and explanations about this choice.
Establishing a visual context (i.e., setting) of TMH session	For youngsters, clinicians should be aware that providing the possibility of a virtual tour of their office might assure young people that none else is present and/or give some context to the clinical setting in which TMH session is taking place. In some settings, it may be possible or even desirable, to allow patients to manipulate the remote control during the TMH session. Clinicians should clearly state which is the setting in which the TMH session is going (i.e., inpatient service, traditional outpatient service, public versus private practice, university hospital with the possibility that students may assist the TMH session, nonmedical facilities such as schools, juvenile justice settings, primary care, or nonclinical settings such as home). The type of service site will have implications for the model of care and operational procedures, such as staffing, patient selection, patient management, safety, and emergency planning.
Discussing how to manage occurring technical issues	Clinicians are encouraged to discuss any technical difficulties and how to manage them (i.e., slight lag in audio, video or distortions, lack of Wi-Fi connection, etc.). Clinicians should firstly prepare and provide to patient a B plan in case any technical issue may occur and interfere with TMH session. Adolescents with a parent or other family member present may need a camera with an appropriate adjustment to accommodate two or more individuals in the frame.
Offering a space for open questions	Clinicians should give the possibility to young patients (and their parents/family) to ask questions before starting TMH session. This may be especially helpful to younger patients (and their parents/caregiver) who are not as comfortable with electronic media.
Obtain informed consent	Clinicians should evaluate if they prefer to obtain informed written and signed consent in-person (maybe during a first pre-evaluation visit) or electronically (i.e., by email). Clinicians should evaluate if they prefer to perform an ad hoc informed consent for TMH different from that used to provide in-person intervention.
Obtain written and signed emergency shared plan	A key component of TMH care delivery is developing a comprehensive safety and emergency management planning including standard operating procedures and protocols for managing urgent needs and psychiatric emergencies, including a concrete crisis plan with the patient and the family. Clinicians should agree with young patient (and their parents/caregiver) who is the referee person in case of any emergency occurring during a TMH session and which is the plan to be followed in any case. An emergency plan should clearly assign responsibility for contacting emergency and other necessary personnel in the event of an emergency. Clinicians shall consider involving family members in emergency treatment situations when possible and clinically appropriate, particularly in case of young patients. Clinicians should be aware and know if specific emergency procedures exist for any site (e.g., school) where the TMH session takes place. If none exists, clinicians should establish emergency procedures, including who will do what at each site to ensure coordination, a prompt management and intervention in emergencies. Emergencies occurring between visits should be managed as for usual.