TABLE 1.

Summary of articles included in systematic review (N = 38)

References	N	Providers sampled and TMH-V experience	TMH-V services provided	Patients served	Location of patients’ TMH-V care	Study design and/or provider measures (Additional collected data not analyzed in current review included in italics)	Main findings
1. Adler et al. (2014)	12	Psychologists, social workers, and counselors; 2 of the 12 clinicians ultimately provided TMH-V	Psychotherapy	Veterans in South Central United States	VA community-based outpatient clinics	Pre–post surveys of providers who both did and did not engage in TMH-V intervention	Adopters had more positive views of TMH-V at preassessment and nonadopters endorsed more barriers. Adopters noted increases in knowledge, confidence, and motivation at postassessment. Intervention was less disruptive than initially imagined
2. Austen and McGrath (2006)	134	Nurses, psychologists, and psychiatrists; 12% had TMH-V experience	Psychotherapy and/or medication management	Deaf and nondeaf patients in the UK	Unknown or not applicable	Questionnaire	Those with experience using TMH-V felt more confident regarding their abilities to use the technology. Providers report relatively low access to TMH-V technologies
3. Baird et al. (2018)	83	Psychiatric advanced practice nurses; 63% had TMH-V experience	Telenursing	Children and adults in the United States	Unknown or not applicable	Online survey	Attitudes toward TMH-V were positive overall, and providers would like more training
4. Brooks et al. (2012)	39	Unspecified clinicians involved in developing 3 TMH-V clinics	Psychotherapy and/or medication management	Native American Veterans in the Northern Plains	VA community-based outpatient clinics	Semi-structured phone interviews Implementation process and timeline data also collected	Positive impressions of TMH-V increased over time from 67% to 82%, due to providers gaining experience and receiving positive feedback from patients and staff
5. Cipolletta and Mocellin (2018)	289	Psychologists; 8.3% had TMH-V experience	Psychotherapy	Patients in Italy	Unknown or not applicable	Anonymous survey E-mail, text, and online forum data also collected	62.6% were favorable toward TMH-V
6. Cruz et al. (2005)	4	Psychiatrists, psychologist; all provided TMH-V care	Psychotherapy, medication management, and/or consultation	Children, adolescents, and adults in Arizona	Referring rural hospitals with no mental health providers	Satisfaction form completed after each patient contact Patient data (satisfaction, diagnoses, demographics, # of visits) also collected	Providers noted that TMH-V improved clinical efficiency for 61% of appointments, but were generally less satisfied with TMH-V and endorsed more barriers than their patients
7. Cunningham et al. (2013)	10	Psychiatrists, social workers, and counselors; all provided TMH-V care	Consultation	Schoolchildren in urban Maryland	8 schools	Anonymous online survey	Providers reported positive experiences with TMH-V, rated comfort using technology as 9.75 out of 10 and described process as efficient
8. Elford et al. (2000)	5	Psychiatrists; all provided TMH-V care	Diagnostic assessments	Children and adolescents in Newfoundland	Child psychiatry center within a hospital	Pre–post surveys of TMH-V intervention, satisfaction questionnaires after each assessment Also measured agreement between TMH-V and in-person diagnoses and patient/parent satisfaction	21 of 23 sessions rated as going moderately well or very well. All psychiatrists endorsed TMH-V as acceptable alternative to in-person sessions, but they prefer in-person and feel it allows for better communication. Noted fewer barriers and less skepticism toward TMH-V at follow-up compared to baseline
9. Elford et al. (2001)	5	Psychiatrists; all provided TMH-V care	Diagnostic assessments	Children and adolescents in Newfoundland	Child psychiatry center within a hospital	Satisfaction questionnaires after each assessment Patient/parent satisfaction and cost data also collected	All 25 assessments rated as satisfactory or very satisfactory. 21 were rated as equivalent to in-person, 3 as not as good but “good enough,” and 1 as superior to in-person due to ability to zoom camera on facial tic for diagnostic purposes
10. Ertelt et al. (2011)	6	Psychologists; all provided both TMH-V and in-person care	Cognitive behavioral therapy for bulimia	Adults with bulimia diagnoses in North Dakota and Minnesota	Distal therapy sites	RCT comparing TMH-V to in-person treatment. Providers completed Working Alliance Inventory (WAI) questionnaire Patient WAI data also collected	Providers rated adherence to therapeutic tasks, goals, and therapeutic bond significantly higher for in-person versus TMH-V sessions; TMH-V means were 1–2 points lower than in-person. No significant differences in patient ratings of in-person and TMH-V sessions
11. Gelber (2001)	25	Unspecified clinicians; all delivered TMH-V care	Consultation and other clinical work	Children and adolescents in rural Australia	CAMHS clinics	Telephone survey Length and frequency of use data also collected	50% valued TMH-V use and 45% valued highly. 96% reported an increased comfort level over time, described adapting to the technology
12. Gibson et al. (2011)	68	Psychologists, psychiatrists, social workers, and nurses; 49% had TMH-V experience	Consultation	Patients in remote and rural First Nations communities in Canada	Community centers	Online survey of all providers and qualitative interviews of those with TMH-V experience Frequency of use data also collected	50% of survey respondents rate TMH-V as useful, 9% rate as not useful at all. Those who rated TMH-V as easier and more useful and who underwent training were more likely to use TMH-V more often. TMH-V is described as becoming easier to use with more experience
13. Gilmore and Ward-Ciesielski (2019)	52	Masters and PhD level psychotherapists; 50% had TMH-V experience	Psychotherapy	Patients with acute suicide risk in the United States	Unknown or not applicable	Online survey	Providers who had more positive attitudes toward TMH-V and had more years in practice were more likely to use TMH-V with patients at high risk for suicide
14. Glover et al. (2013)	283	Psychiatry residents; 18% had TMH-V experience	Medication management	Children, adolescents, and adults in the United States	Unknown or not applicable	Online survey Frequency of use data also collected	72% were interested/very interested in TMH-V. 72% of those with prior experience said that their interest in TMH-V increased with use. 40% said TMH-V is not equal to in-person care, while 34% felt it is equal
15. Glueckauf et al. (2018)	164	Psychologists; 26% had TMH-V experience	Psychotherapy	Children, adolescents, and adults in the United States	Unknown or not applicable	Anonymous online survey Telephone, text, e-mail, and frequency of use data also collected	73% describe TMH-V as useful
16. Gordon et al. (2015)	176	Psychologists, psychiatrists, and social workers; 79% had used TMH-V for >3 years	Psychodynamic psychotherapy	Students in China	Patient’s home	Online survey Attitudes toward teaching and supervision via telehealth also measured	TMH-V rated as “slightly less effective” than in-person care on factors such as symptom reduction, privacy, exploring transference and countertransference, and relational problems
17. Interian et al. (2017)	33	Psychologists, psychiatrists, social workers, and nurses; 61% had TMH-V experience	Psychotherapy	Urban, suburban, and rural US veterans	Patient’s home	Semi-structured interviews Implementation process and rate of uptake data also collected	Those with no TMH-V experience more consistently questioned the effectiveness of TMH-V as compared to current users. Current users noted satisfaction with TMH-V but also encountered significant logistical barriers
18. Jameson et al. (2011)	86	Psychologists, psychiatrists, social workers, and therapists; 58% had TMH-V experience	Medication management and psychotherapy	Urban and rural veterans in southern United States	VA community-based outpatie	Semi-structured interviews and phone surveys Utilization data also collected	Effectiveness scores for diagnostic interviews and psychotherapy were positive. Providers wanted to see research comparing TMH-V to in-person effectiveness, noted loss of in-person contact and technical issues as barriers
19. Kopel et al. (2001)	8	Psychiatrists; all providers delivered TMH-V care	Assessment and consultation	Children and adolescents in rural New South Wales	Mental health clinics	Technology evaluation questionnaire completed after each assessment Patient and parent satisfaction data also collected	79% of sessions rated as adequate compared to in-person, 15% almost as good, 4% poor, and 1% rated as good as in-person. Ease of use rated as fair at 47% of sessions and good or excellent at 49% of sessions. Providers surprised how positively families responded to TMH-V
20. Levy and Strachan (2013)	61	Medical, nursing, and psychology staff; 62% had TMH-V experience	Assessment and intervention	Children and adolescents in rural Scotland	CAMHS clinics	Online and paper surveys	Majority think TMH-V would improve local access and are willing to introduce it into their service, but most would prefer in-person care
21. Lindsay et al. (2017)	5	Psychologists, social workers, counselors, and psychology interns; all delivered TMH-V care during intervention	Psychotherapy	Veterans in rural Mississippi	Patient’s home	Qualitative phone interviews Implementation process and uptake data also collected; qualitative interviews also conducted with patients	Overall satisfaction with TMH-V modality. Providers noted multiple barriers to use but described being flexible and adapting following unforeseen technological issues
22. Mayworm et al. (2019)	7	Psychiatrists; all conducted TMH-V and in-person sessions	Medication management and assessment	Schoolchildren in Baltimore	25 schools	Anonymous satisfaction surveys, focus groups Patient, caregiver, and referring clinician satisfaction data also collected; efficiency analyses also conducted	Providers rated satisfaction with TMH-V as 4 out of 5. Note increased access to care and flexibility. Ease of use rated lower. Providers preferred in-person sessions but satisfaction rates were similar between modalities
23. Mitchell et al. (2009)	19	Psychologists, psychiatrists, social worker, and nurse; all with TMH-V experience	Direct clinical care	Children and adolescents in Scotland	CAMHS clinics and hospitals	Questionnaires	79% prefer TMH-V over telephone communication. More benefits of TMH-V were noted as compared to drawbacks
24. Monthuy-Blanc et al. (2013)	205	Psychologists, social workers, nurses, natural helpers; none had TMH-V experience	Psychotherapy	First Nations communities in Canada	Unknown or not applicable	Technology Acceptance Questionnaire	The only significant predictor of providers’ intention to use TMH-V was its perceived usefulness
25. Moreau et al. (2018)	40	Psychologists, social workers, primary care providers; some had TMH-V experience	Psychotherapy	Female veterans in urban and rural Midwest and southern United States	VA facilities	Semi-structured qualitative interviews	Providers enthusiastic about using TMH-V to improve access to care for female veterans. Noted multiple barriers including technology challenges and need for safety protocols
26. Newman et al. (2016)	>40	Psychiatrists, nurse practitioners; some had TMH-V experience	Psychotherapy and assessment	Patients in rural Australia	Hospitals and clinics	Phone interviews and focus groups Utilization data also collected	TMH-V accepted to varying extents across providers, with many citing its ability to increase access. Multiple drawbacks noted as well as a need for further training and development of “telehealth culture”
27. Perle et al. (2014)	782	Psychologists and trainees; 19.4% had TMH-V experience	Psychotherapy	Patients in the United States and Canada	Unknown or not applicable	Online surveys	79.5% agreed that TMH-V can be effective treatment; fewer (58.3%) felt TMH-V to patient’s home would be effective. 42% unsure whether TMH-V is as effective as in-person care
28. Pesämaa et al. (2007)	26	Psychiatrists; all had TMH-V experience	Consultation	Children and adolescents in Finland	Hospitals	Questionnaire Utilization data also collected	All providers agreed that TMH-V saves time, costs, and work; 35% agreed that it improves the quality of services. Multiple technological barriers to use noted
29. Ruskin et al. (2004)	8	Psychiatrists; all provided both TMH-V and in-person care	8 sessions of medication management and supportive counseling over 6 months	Veterans in Maryland	VA facility	RCT comparing TMH-V to in-person treatment. Satisfaction questionnaire completed at week 26 Patient satisfaction, adherence, treatment outcome, and cost data also collected	Psychiatrist satisfaction was significantly greater for in-person sessions versus TMH-V. However, satisfaction ratings were high in both conditions, suggesting positive perception of TMH-V
30. Schopp et al. (2000)	9	Psychologists and trainees; all conducted TMH-V and in-person sessions	Clinical interviews	Adults in rural midwestern United States	Hospitals and clinics	Satisfaction questionnaire after each in-person or TMH-V session, and qualitative interviews Patient satisfaction and cost data also collected	Provider satisfaction was significantly higher for in-person versus TMH-V sessions. Providers described greater frustration with technological delays as compared to patients
31. Shulman et al. (2017)	31	Psychiatrists; 6 of whom ultimately provided both TMH-V and in-person care	Medication management and psychotherapy	Patients at a New York hospital outpatient psychiatry clinic	Patient’s home	RCT comparing in-person to TMH-V psychiatric care; providers completed online survey Patient satisfaction and adherence data also collected	Authors reported difficulty recruiting providers; those who agreed only selected a fraction of their patients as appropriate for TMH-V care and reported concerns about technical problems and extra hassle. Patients had more positive opinions of TMH-V experience than providers
32. Simms et al. (2011)	185	Psychologists, psychiatrists, social workers, and nurses; 40% had TMH-V experience	Psychotherapy	Patients, including Veterans, in Canada	Unknown or not applicable	Online survey and qualitative interviews	Majority rated TMH-V as very useful or somewhat useful, but more rated TMH-V as difficult to use as compared to easy. Those using TMH-V more frequently had more years in practice, more training, and perceived technology as useful and easy. Discussed barriers such as safety concerns and noted developing solutions
33. Starling and Foley (2006)	27	Psychologists, psychiatrists, and social workers; all participated in TMH-V intervention	Consultation	Children and adolescents in rural New South Wales	Clinics	Questionnaire	53% rated TMH-V as effective. Two providers reported it was “twice as hard” to conduct TMH-V sessions versus in-person due to difficulties engaging families, having to use shorter sentences and less nonverbal communication
34. Thomas et al. (2017)	148	Psychiatrists and social workers; all providers delivered TMH-V care	Psychiatric emergency consultation	Children and adolescents in Colorado	Emergency departments	Telehealth satisfaction instrument completed after each consultation Utilization and caregiver/referring provider satisfaction data also collected	Providers rated TMH-V as acceptable and rated ease of use and quality of care positively. Provider satisfaction scores were lower than those of referring providers and caregivers, likely due to increased workload, concerns regarding developing therapeutic alliance, and making accurate diagnoses
35. Volpe et al. (2013)	36	Psychiatrists, 83% had TMH-V experience	Consultation and short-term follow-up	Children and adolescents in rural Ontario, Australia, and the United States	Mental health clinics and ho	Online survey of 26 providers, focus groups, and qualitative interviews with 10 providers with TMH-V experience	68% of survey respondents described TMH-V as an important innovation providing increased access to care. 40% of survey respondents and majority of interviewees endorsed little to no differences between TMH-V and in-person consultations
36. Wagnild et al. (2006)	11	Psychiatrists; all had TMH-V experience	Medication management	Children, adolescents, and adults in rural Montana	Hospitals and clinics	Semi-structured interviews	Four of 11 providers reported satisfaction with TMH-V. Agreed that TMH-V improves access but cited many barriers including technology issues, difficulty establishing rapport, and trouble reading nonverbal cues
37. Whitten and Kuwahara (2004)	36	Psychiatrists; all participated in TMH-V intervention	Consultation	Children, adolescents, and adults in rural and urban Michigan	Clinic, youth center, crisis h homes	Pre–post focus groups and interviews during project implementation period Utilization and patient satisfaction data also collected	Majority of providers either started project with positive attitude toward TMH-V or developed positive attitude during participation; 1 provider reported negative attitude toward TMH-V before and during implementation. Majority were reluctant to initiate TMH-V but were pleasantly surprised by level of TMH-V acceptance by their patients
38. Wynn et al. (2012)	11	Psychologists and psychiatrists; none had TMH-V experience	Consultation	Patients in Norway	Not applicable	Qualitative interview	Providers were in general positive toward TMH-V given that they could first meet in-person. Had multiple concerns regarding potential effectiveness, technological difficulties, lack of training, and trouble developing rapport

Abbreviations: CAMHS, Child and Adolescent Mental Health Services; RCT, randomized controlled trial; TMH-V, telemental health via videoconferencing.