TABLE 1.
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.