Skip to main content
NCBI home page
SAGE - PMC COVID-19 Collection logoLink to SAGE - PMC COVID-19 Collection
. 2023 Mar 7:1357633X231157103. doi: 10.1177/1357633X231157103

Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists

Elena von Wirth 1, Lea Meininger 1, Julia Adam 1, Katrin Woitecki 1, Anne-Katrin Treier 1, Manfred Döpfner 1,2,✉
PMCID: PMC9996161  PMID: 36883237

Abstract

Introduction

Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing.

Methods

Caregivers (parents) and psychotherapists of n  =  228 patients (4–20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1).

Results

At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists’ ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35).

Conclusion

The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).

Keywords: Telemedicine, teletherapy, psychotherapy, cognitive-behavioral therapy, treatment satisfaction

Introduction

Children and adolescents were highly burdened during the global coronavirus disease 2019 (COVID-19) pandemic. Studies revealed significant increases in mental health problems due to infection protection measures (e.g. lockdown, school closures, and peer contact reductions) among children and adolescents.1,2 Especially those with previous mental health problems were found to be highly vulnerable to experiencing psychological distress and worsening of symptoms during the pandemic.3

Psychotherapy delivered via real-time, interactive videoconferencing (teletherapy) offered a unique opportunity to provide mental healthcare without the risk of spreading the COVID-19 virus. Cognitive-behavioral therapy (CBT) is the current gold standard of psychotherapy and videoconference-delivered CBT has been found to be a feasible and effective alternative to face-to-face CBT.4,5 Pre-COVID-19 studies demonstrated that patients were equally satisfied with teletherapy as they were with face-to-face interventions,6 although working alliance in teletherapy seemed to be inferior to face-to-face delivery.7 Surveys conducted in 2020 revealed that psychotherapists were generally satisfied with teletherapy during the early phases of the COVID-19 pandemic and reported having a sufficient working alliance with their patient during online sessions.8,9

Unfortunately, most evidence regarding teletherapy derived from adult populations and there is relatively little published research on teletherapy for children and adolescents. This gap of knowledge is problematic because results regarding adults may not generalize to youths. Clinic records revealed that child mental health services returned more rapidly to face-to-face services after the COVID-19 lockdown than adult services, suggesting that telemedicine may be a less preferred method of service delivery for children.10 Especially very young children and children unable to sit at screen due to attentional or behavioral difficulties have been described as being disadvantaged by remotely delivered mental health services.11 In addition, clinicians reported missing the ability to rely on nonverbal communication in their interactions with children and have expressed patient safety concerns.11,12

Mental healthcare providers working with children and adolescents have also described many positive experiences with telemedicine. Advantages include an increased flexibility enabling families to overcome pre-existing barriers to in-person care (e.g. work commitments, childcare, and lack of transport), care providers being able to see the patient in their own home and to observe authentic parent–child interactions, and patients being able to talk more freely about their feelings and experiences.11,13,14 Moreover, several pre-COVID-19 studies demonstrated that teletherapy is a feasible and effective method of treatment delivery for children and adolescents.15 A few randomized controlled trials, albeit with small samples, have demonstrated that videoconference-delivered CBT is as effective as face-to-face treatment for youths with obsessive-compulsive disorder,16,17 depression,18 and tic disorder,19,20 as well as for parents of children with attention-deficit/hyperactivity disorder.21,22 Patients and parents who participated in these studies endorsed high levels of satisfaction with teletherapy17,23 with no difference in satisfaction between teletherapy and face-to-face treatment.16,19,21

Similar findings were obtained during the early phases of the COVID-19 pandemic. In 2020 patients and providers reported being highly satisfied with videoconference-delivered CBT in routine child and adolescent mental healthcare.24,25 Information regarding factors influencing satisfaction with teletherapy is limited. A recent survey found that therapeutic alliance and satisfaction with teletherapy increased with increasing age of the patient.24 Another survey revealed that anxious/depressed adolescents had greater difficulties establishing a therapeutic alliance during videoconference sessions compared to adolescents with less internalizing symptoms.26

In our own study,27 we evaluated the implementation of teletherapy in a large sample of children and adolescents (n  =  643, aged 3–20 years) treated in a university outpatient clinic in Germany in the first quarter of 2020. Following the outbreak of COVID-19, 73% of patients shifted from face-to-face CBT to videoconference-delivered CBT. Both parents and therapists reported high levels of satisfaction with teletherapy. The majority of therapists (73%) and parents (89%) reported being partially or fully satisfied with teletherapy sessions. Moreover, more than half of therapists (65%) and parents (75%) reported that the therapeutic relationship with the patient had not changed due to the use of teletherapy. These findings demonstrated that teletherapy was a feasible and well-accepted method of treatment delivery during the first wave of the COVID-19 pandemic.

However, it is unknown whether the high level of satisfaction with teletherapy found in 2020 is attributable to the situation in which psychotherapists found themselves. Face-to-face appointments with patients were difficult to realize during lockdown or may have been perceived as dangerous due to the risk of infection. Yet, psychotherapists may have felt committed to provide continuous care for their patients.28 It is, therefore, possible that satisfaction with teletherapy in routine care decreased after social distancing regulations were eased, but longitudinal data on satisfaction with teletherapy during the COVID-19 pandemic has not yet been published.

The aim of the present study is to investigate the long-term satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach that combined videoconference-delivered and in-person-delivered CBT for children and adolescents with mental health problems treated in routine clinical practice during the COVID-19 pandemic.

Methods

Participants

N  =  643 patients treated at the outpatient unit of the School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Germany, in the first quarter of 2020 had participated in the first survey (T1), which was conducted between July and October 2020. Of these, n  =  196 were not asked to participate in the follow-up (FU) survey (T2) on treatment satisfaction because they had completed outpatient treatment at T1. N  =  219 of the remaining patients refused participation at T2. Figure 1 shows the flow of participants. A total of n  =  228 patients (aged 4–20 years) participated in the FU survey, which was conducted between May and July 2021. Therapist ratings were available for 168 patients. Parent ratings were available for 92 patients. For 32 patients, both ratings were collected.

Figure 1.

Figure 1.

Open in a new tab

Flow of participants.

Intervention

All patients received CBT. Face-to-face treatment was delivered at AKiP. Teletherapy was delivered via real-time, interactive videoconferencing. Video sessions were delivered in accordance with the guidelines for webcam-based telemental health of the German National Association of Statutory Health Insurance Physicians using the software platform Arztkonsultation (www.arztkonsultation.de), which has been certified regarding data protection and security.29 The therapists used a tablet or computer with webcam in the outpatient clinic. The patients and/or their parent/caregivers used their own computer with a webcam, laptop, tablet, or smartphone. N  =  128 participants had completed treatment between the first survey (T1) and the FU survey (T2) (treatment duration in months: M  =  19.1 (SD  =  8.1), minimum  =  6 months, maximum  =  36 months). The remaining n  =  100 participants were still receiving treatment at T2.

Measures

Questionnaire to assess the implementation of and satisfaction with teletherapy. This questionnaire was developed for the purpose of the study (see Electronic supplemental material (ESM) for a full list of items and detailed information on calculation of subscale scores). It contains 15 items in the therapist version (T) and eleven items in the parent version (P). At the start of both versions, respondents are asked whether teletherapy sessions have occurred since lockdown and if not, to provide reasons. If teletherapy sessions occurred, respondents are next asked to indicate the number of teletherapy sessions conducted (only therapist version) and the persons involved in the teletherapy (e.g. patient, caregiver). Treatment satisfaction is assessed with seven items in the therapist version and four items in the parent version. The satisfaction items assess (a) whether the internet connection was stable, (b) the satisfaction with teletherapy, and (c) whether the respondents intend to use teletherapy after the pandemic. Individual scores on the satisfaction items were averaged to obtain a mean satisfaction score (MSS). In both versions, changes in treatment satisfaction and in the therapeutic relationship due the transition to teletherapy are assessed with four items rated on a five-point scale from much worse (−2) to much better (2) (see ESM). Individual scores on these items were averaged to obtain a mean satisfaction change score (MCS). If respondents do not intend to use teletherapy in the future, the FU survey contained an additional item that asked to respondents to provide reasons (P12 / T16).

Corona Child Stress Scale (CCSS30). This questionnaire is based on the Coronavirus Health and Impact Survey (CRISIS31). For the present study, the parent version (14 items) and an analogously developed therapist version (six items) were used (see ESM). Both versions contain six items regarding pandemic-related changes in family relationships, school and learning, mental health symptoms, and therapy. The parent version also assesses changes in the child's peer relationships, daycare, leisure time, and psychopharmacotherapy, and parents’ work and family situation. Items are rated on a five-point Likert scale from −2 to 2, with higher scores representing a higher pandemic-related burden. Internal consistency of the two versions was acceptable to good (Cronbach's α ≥ .74).27,32

Basic Documentation.33 This therapist-completed scale records information about the patient at the time of admission. Psychosocial functioning rating is assessed with the Children's Global Assessment Scale.3 For the present analyses, the following variables were extracted: child age, gender, socio-economic status, psychosocial functioning, and diagnosis.

German versions of Child Behavior Checklist (CBCL/6-18R) and Youth Self Report (YSR/ 11-18R).35 These parent report (CBCL; patients ≥ 6 years) and self-report (YSR; patients ≥ 11 years) questionnaires contain 120 and 105 items, respectively, that ask about behavioral and emotional problems and physical complaints. They are rated on a three-point scale from not true (0) to very true or often true (2). Higher scores indicate greater symptom severity. Both questionnaires consist of eight problem scales and two broad-band syndrome scales assessing internalizing problems and externalizing problems (Cronbach's α > .8035).

Procedure

The CCSS and the study questionnaire were conducted either online (using the LimeSurvey survey tool36) or by paper-and-pencil. Therapists received the questionnaires pseudonymized for each patient by email. Parents received the questionnaires by email (n  =  52, 57% of n  =  92) or by post if no email address was available (n  =  40, 43%). The respondents received several reminders to participate.

N  =  643 patients had participated in the first survey (T1). Respondents who participated in the FU survey (n  =  228) had completed the first survey between July 27 and September 17, 2020 (parent rating) or between June 15 and August 18, 2020 (therapist rating). Parents completed the FU survey between June 1 and July 12, 2021. Therapists completed the FU between May 17 and July 4, 2021. The remaining rating scales are routinely collected at AKiP as part of the standard intake assessment. The study was approved by the Ethics Committee of the Medical Faculty of the University of Cologne, Germany. Information on missing data and the statistical analyses is provided in the ESM.

Results

Participants

The characteristics of the total sample with available therapist and/or parent rating (n  =  228) and the two subsamples (parent rating (n  =  92); therapist rating (n  =  168)) are presented in Supplemental Table 1 (ESM). The patients were aged from 4 to 20 years. There were slightly more male patients (56%). Approximately 46% of patients had a clinical diagnosis of an externalizing disorder (e.g. attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) at the time of admission. About 48% had an internalizing disorder (e.g. anxiety disorder, obsessive-compulsive disorder, and depressive disorder).

Implementation and acceptance of teletherapy at follow up

All patients received face-to-face sessions. Therapists of n  =  132 patients (78.6% of n  =  168) reported at T2 that they had conducted blended treatment including both face-to-face sessions and teletherapy. If teletherapy had been conducted, therapists reported that the number of videoconference sessions ranged between 1 and 45 sessions (M  =  10.86, SD  =  7.91). For 11 patients (6.6% of n  =  168), therapists had reported at T1 that they had not conducted teletherapy with this patient or the caregiver(s), suggesting that teletherapy was first conducted between T1 and T2.

At T2, therapists of n  =  61 patients (46.2% of n  =  132) reported that both the patient and his or her caregiver(s) participated in teletherapy sessions. Therapists of n  =  49 patients (37.1% of n  =  132) reported that only the patient participated in teletherapy. In n  =  22 cases (16.7% of n =  132), only the caregiver(s) participated in teletherapy sessions. Overall, n  =  110 patients (83.3% of n  =  132) participated in teletherapy. Caregivers conducted teletherapy in n  =  83 cases (62.9% of n  =  132). The mother participated in n  =  77 cases (58.3% of n  =  132), the father in n =  28 cases (21.2% of n  =  132), and another caregiver in n  =  8 cases (6.1% of n  =  132).

Similarly, n  =  68 parents (73.9% of n  =  92) reported that their child's treatment included teletherapy sessions. Nine of these parents (8.7% of n  =  92) reported that they or their child had first received teletherapy between T1 and T2.

Satisfaction with teletherapy

Table 1 provides the descriptive statistics of therapists’ satisfaction with teletherapy provided as part of a blended treatment approach at T1 and T2. Wilcoxon tests revealed that, for most items assessing treatment satisfaction, therapists’ ratings of satisfaction with teletherapy did not change significantly from T1 to T2. At T2, 76.5% of therapists reported that the internet connection was at least partially stable (item T5). And 70.9% of therapists indicated that the patient was at least partially satisfied with teletherapy (item T6), 91.5% indicated that the caregiver was at least partially satisfied with teletherapy (item T7), and 62.1% indicated that they themselves were at least partially satisfied with teletherapy (item T8). However, 82.6% of therapists reported that teletherapy restricted their therapeutic options (item T9) and only 37.1% reported that teletherapy extended their therapeutic options (item T10). Therapists’ intention to use teletherapy in the future (item T15) increased significantly from T1 to T2 (p  =  .04). At T2, the majority of therapists reported that they intend to use teletherapy partly (50.0%) or mostly (10.6%). At T1, only 46.2% of the therapists in the present sample had reported that they intended to use teletherapy in the future.

Table 1.

Satisfaction with teletherapy (item scores, therapist rating).

T1 T2 Frequencies at T2  
Item N2 M (SD) N2 M (SD) n (%) T1 vs T21
Not true (0) Rather not true (1) Partially true (2) Very true (3)  
T5: stable internet connection 119 1.87 (0.81) 132 1.86 (0.81) 11 (8.3) 20 (15.2) 77 (58.3) 24 (18.2)   T1  =  T2
T6: overall satisfaction patient 114 1.97 (0.89) 110 1.87 (0.94) 12 (10.9) 20 (18.2) 48 (43.6) 30 (27.3)   T1  =  T2
T7: overall satisfaction caregivers 82 2.23 (0.82) 83 2.24 (0.64) 1 (1.2) 6 (7.2) 49 (57.8) 28 (33.7)   T1  =  T2
T8: overall satisfaction therapists 119 1.76 (0.88) 132 1.67 (0.93) 18 (13.6) 32 (24.2) 58 (43.9) 24 (18.2)   T1  =  T2
T9: restriction of therapeutic options3 119 1.01 (0.75) 132 1.02 (0.80) 10 (7.6) 13 (9.8) 78 (59.1) 31 (23.5)   T1  =  T2
T10: extension of therapeutic options 119 1.27 (0.85) 132 1.23 (0.76) 22 (16.7) 61 (46.2) 45 (34.1) 4 (3.0)    
          No (0) Yes, partly (1) Yes, mostly (2) Yes, exclusively (3)    
T15: teletherapy in future 119 0.57 (0.61) 132 0.71 (0.65) 52 (39.4) 66 (50.0) 14 (10.6) 0 (0.0)   T1 < T2*
Mean satisfaction score 119 1.40 (0.63) 132 1.42 (0.58)           T1  =  T2
          Much worse (−2) A little worse (−1) unchanged (0) a little better (1) Much better (2)  
T11: change in patient satisfaction 114 - 0.19 (0.61) 110 −0.17 (0.65) 2 (1.8) 28 (25.5) 67 (60.9) 13 (11.8) 0 (0.0) T1  =  T2
T12: change in caregiver satisfaction 82 0.07 (0.44) 83 −0.11 (0.49) 0 (0.0) 15 (18.1) 62 (74.7) 6 (7.2) 0 (0.0) T1 > T2*
T13: change in relationship patient-therapist 114 - 0.14 (0.65) 110 1.11 (1.10) 0 (0.0) 9 (8.2) 33 (30.0) 5 (4.5) 63 (57.3) T1 < T2*
T14: change in relationship caregiver- therapist 82 0.15 (0.42) 83 −0.71 (0.79) 2 (2.4) 65 (78.3) 11 (13.3) 0 (0.0) 5 (6.0) T1 > T2*
Mean change score 119 - 0.06 (0.29) 132 0.11 (0.63)           T1 < T2*
Open in a new tab

Note: n: absolute frequencies, sample size varies due to missings; %: percentage frequencies; M :mean, SD: standard deviation.

1

Wilcoxon test to examine differences between T1 and T2, * p < .05.

2

Sample sizes at T1 differ from those at T2 because n  =  11 patients had started teletherapy after T1 and n  =  2 therapists had not participated in the T1 survey.

3

Answers to item T9 were recoded before satisfaction items were average to obtain the mean satisfacton score (MSS). After recoding, higher scores on item T9 reflect less restrictions (= higher satisfaction).

Therapists’ ratings of changes in treatment satisfaction and in the therapeutic relationship due to the use of teletherapy revealed significant changes from T1 to T2 (Wilcoxon tests). Therapists’ ratings of the impact of the use of teletherapy on caregivers’ treatment satisfaction (item T12) worsened significantly from T1 and T2 (p < .01). At T2, most therapists (74.7%) indicated that caregivers’ treatment satisfaction was unchanged, 18.1% reported that the caregivers’ treatment satisfaction had become a little worse, and only 7.2% reported that caregivers’ treatment satisfaction had become a little better. Similarly, the impact of the use of teletherapy on the therapeutic relationship with the caregivers (item T14) worsened significantly from T1 and T2 (p < .001). At T2, the majority of therapists indicated that the relationship with caregivers had become a little worse (78.3%) or much worse (2.4%).

In contrast, the therapist-rated impact of teletherapy on the therapeutic relationship with the patient (item T13) improved significantly over time (p < .001). At T2, more than half of the therapists indicated that the patient–therapist relationship was improved a little (4.5%) or much (57.3%) due to the use of teletherapy. Therapists’ ratings of the impact of teletherapy on the patients’ treatment satisfaction (item T11) did not change over time. At T2, most therapists (60.9%) indicated that patients’ treatment satisfaction was unchanged, 27.3% reported that the caregivers’ treatment satisfaction had become worse, and 11.8% reported that caregivers’ treatment satisfaction had become a little better. The therapist-rated MCS was significantly higher at T2 compared to T1 (p  =  .02), suggesting that the impact of teletherapy on treatment satisfaction and the therapeutic relationship was viewed to be more positive at T2 compared to T1.

Table 2 provides the descriptive statistics of parents’ satisfaction with teletherapy at T1 and T2. Wilcoxon tests revealed that parents’ satisfaction with teletherapy did not change significantly from T1 to T2. At T2, 94.0% of parents reported that the internet connection was at least partially stable (item P4). The majority of parents (93.7%) were at least partially satisfied with teletherapy (item P5). Similarly, 87.9% of parents indicated that the child was at least partially satisfied with teletherapy (item P6). Parents’ intention to use teletherapy in the future (item P11) was also stable over time. At T2, the majority of parents reported that they intended to use teletherapy partly (69.1%) or mostly (11.8%).

Table 2.

Satisfaction with teletherapy (item scores, parent-rating).

T1 T2 Frequencies at T2  
Item N2 M (SD) N2 M (SD) n (%) T1 vs T21
Not true (0) Rather not true (1) Partially true (2) Very true (3)    
P4: stable internet connection 43 2.30 (0.77) 67 2.33 (0.64) 1 (1.5) 3 (4.5) 36 (53.7) 27 (40.3)   T1  =  T2
P5: overall satisfaction caregiver 43 2.40 (0.62) 64 2.47 (0.62) 0 (0.0) 4 (6.3) 26 (40.6) 34 (53.1)   T1  =  T2
P6: overall satisfaction patient 39 2.05 (0.86) 58 2.26 (0.66) 0 (0.0) 7 (12.1) 29 (50.0) 22 (37.9)   T1  =  T2
          No (0) Yes, partly (1) Yes, mostly (2) Yes, exclusively (3)    
P11: teletherapy in future 43 0.95 (0.72) 68 0.93 (0.56) 13 (19.1) 47 (69.1) 8 (11.8) 0 (0.0)   T1  =  T2
Mean satisfaction score 43 1.84 (0.57) 68 1.88 (0.41)            
          Much worse (−2) A little worse (−1) Unchanged (0) A little better (1) Much better (2)  
P7: change in caregiver satisfaction 43 0.02 (0.51) 68 0.04 (0.63) 0 (0.0) 8 (11.8) 53 (77.9) 3 (4.4) 4 (5.9) T1  =  T2
P8: change in patient satisfaction 43 0.00 (0.62) 68 −0.04 (0.72) 0 (0.0) 15 (22.1) 45 (66.2) 4 (5.9) 4 (5.9) T1  =  T2
P9: change in relationship caregiver- therapist 43 0.12 (0.50) 68 0.00 (0.36) 0 (0.0) 3 (4.7) 59 (92.2) 1 (1.6) 1 (1.6) T1  =  T2
P10: change in relationship patient-therapist 43 0.02 (0.67) 68 −0.07 (0.50) 0 (0.0) 10 (14.7) 54 (79.4) 3 (4.4) 1 (1.5) T1  =  T2
Mean change score 43 0.08 (0.41) 68 −0.02 (0.41)           T1  =  T2
Open in a new tab

Note: n: absolute frequencies, sample size varies due to missings; %:  percentage frequencies; M: mean, SD: standard deviation.

1

Wilcoxon test to examine differences between T1 and T2, * p < .05.

2

Sample sizes at T1 differ from those at T2 because n  =  8 patients had started teletherapy after T1 and n  =  17 parents had not participated in the T1 survey.

Parents’ ratings of changes in treatment satisfaction and in the therapeutic relationship due to the use of teletherapy also did not change significantly from T1 to T2. At T2, most parents (77.9%) indicated that their treatment satisfaction was unchanged, 11.8% reported that their treatment satisfaction has become a little worse, and only few reported that caregivers’ treatment satisfaction has become a little (4.4%) or much (5.9%) better. Similarly, the majority of parents indicated that their child's treatment satisfaction was unchanged (66.2%), about one-fifth (22.1%) reported that their child's satisfaction had become a little worse, and only few parents reported that their child's treatment satisfaction had become a little (5.9%) or much (5.9%) better. In addition, 92.2% of parents reported at T2 that the therapeutic relationship between the therapist and themselves was unchanged. Similarly, the majority of parents (79.4%) indicated that the therapeutic relationship between the therapist and the child was unchanged at T2.

Factors associated with treatment satisfaction

Overall, correlations between parent-rated or therapist-rated satisfaction with teletherapy at T2 and measures of (a) stress due to the COVID-19 pandemic, (b) emotional and behavioral problems, (c) psychosocial functioning, (d) socioeconomic background, (e) the number of teletherapy sessions, and (f) children's age were low (see Supplemental Table 2 in the ESM). Lower therapist-rated satisfaction with teletherapy (MSS) was significantly related to higher stress due to the COVID-19 pandemic at T2 (rated by therapists) (r  =  −.26, p  =  .003, n  =  131) and more externalizing problems at intake (rated by patients) (r  =  −.26, p  =  .04, n  =  64). Lower therapist-rated satisfaction with teletherapy (MSS) was also associated with having conducted less teletherapy sessions (r  =  .19, p  =  .03, n  =  132). Therapist-rated changes in treatment satisfaction and in the therapeutic relationship (MCS) were correlated with parent-rated externalizing problems of the patient at intake. The correlation coefficient was negative (r  =  −.20, p  =  .03, n  =  118), suggesting that a higher level of externalizing problems of the patient was associated with a negative impact of teletherapy on treatment satisfaction and the therapeutic relationship (represented by a lower MCS score). Finally, there was a significant correlation between the therapist-rated MCS and children's age (r  =  .33, p < .001, n  =  132), demonstrating that younger age was associated with a negative impact of teletherapy on treatment satisfaction and the therapeutic relationship. There were no significant correlations between the abovementioned measures and parent-rated treatment satisfaction (MSS and MSC). In addition, there was no difference between boys and girls in therapist-rated or parent-rated treatment satisfaction.

Reasons for not intending to use teletherapy in the future

Detailed information on therapist and parent reported reasons for not intending to use teletherapy in the future is provided in the ESM.

Discussion

This study investigated therapists’ and parents’ satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental health problems treated in routine clinical practice about 1 year after the first COVID-19 pandemic-related lockdown in early 2020. Results revealed that teletherapy sessions were continued to be used in 2021. At follow up, the majority of families (79%) had received blended treatment including face-to-face and teletherapy sessions. Patients and/or their caregivers had received 11 teletherapy sessions on average. The number of teletherapy sessions per family ranged from 1 to 45, demonstrating considerable interindividual variation.

We then examined changes in satisfaction with teletherapy over time. At the 1-year FU, the majority of parents reported that they were satisfied with teletherapy (94%) and that they would opt to use teletherapy in the future (81%). The parents of 92% felt that the therapeutic relationship with the therapist was maintained after the transition from in-person to teletherapy sessions. Parents also provided largely positive feedback regarding their child's treatment satisfaction: Most parents (88%) reported that their child was satisfied with videoconference-delivered CBT and more than half of the parents (59%) felt that neither their child's treatment satisfaction nor the therapeutic relationship between the therapist and their child had changed due to the changeover to teletherapy. However, 22% of parents indicated that their child's treatment satisfaction was a little worse after the use of teletherapy and 15% indicated that the therapeutic relationship between the therapist and their child worsened a little after the use of teletherapy. Yet, there were no significant changes from T1 to T2 on any of the parent-rated items on treatment satisfaction suggesting that the level of satisfaction with videoconference-delivered CBT sessions reported in 2020 was maintained after social distancing regulations were eased and the urgency of conducting teletherapy was reduced.

Somewhat different findings emerged when we analyzed therapists’ ratings of treatment satisfaction. At the 1-year FU, only 62% of the therapists indicated being satisfied with teletherapy and 83% felt that teletherapy restricts their therapeutic options. Yet, therapists’ intention to use teletherapy in the future increased between 2020 and 2021.

Interestingly, therapists’ ratings of the impact of teletherapy on the therapeutic relationship changed significantly over time. In 2020, most therapists reported that the therapeutic relationship with the child and the parent(s) or caregiver(s) was maintained after the transition to teletherapy. At FU, most therapists reported positive impacts of teletherapy on the therapeutic relationship with the child, but not on the relationship with parent(s) or other caregiver(s). More specifically, 62% of therapists indicated that the therapeutic relationship with the child improved due to the use of teletherapy, while 81% of the therapists indicated that the relationship with the parent or other caregiver had deteriorated due to the use of teletherapy.

The latter finding contradicts the results obtained from parents, who mostly reported that they were satisfied with teletherapy and that the therapeutic relationship did not change due to the transition to teletherapy. It is possible that parents experience more benefits from teletherapy (e.g. no travel time and costs) than therapists. It is also possible that the high level of satisfaction reported by parents was caused by a selection bias. Parents who were more satisfied with the treatment and who felt more connected to their child's therapist may have felt more committed to participate in the FU survey, leading to an overestimation of the level of parents’ satisfaction with the teletherapy and the therapeutic relationship. However, T1 ratings of treatment satisfaction did not differ significantly between T1 participants who completed the T2 questionnaire on treatment satisfaction (n  =  43) and those who did not (n  =  123) (MSS: T(164)  =  −1.05, p  =  .30; MCS: T(164)  =  −1.05, p  =  .30), demonstrating that initial satisfaction was not associated with parents’ decision to participate in the FU survey. It is also possible that ratings of treatment satisfaction were influenced by the questionnaire administration time.37 There is evidence that the level of treatment satisfaction is overestimated on questionnaires completed before discharge.38 However, parents of patients who had completed treatment at T2 (n  =  34) and parents of patients who were still in treatment at T2 (n  =  34) did not provide significantly different ratings of satisfaction with teletherapy and the therapeutic relationship at T2 (MSS: T(66)  =  1.0510, p  =  .28; MCS: T(66)  =  0.73, p  =  .47), suggesting that questionnaire administration time did not influence the present results.

We therefore conclude that therapists in the present sample were generally more critical than were the parents. This interpretation is consistent with previous research demonstrating that therapists provide more critical ratings of the quality of the therapeutic relationship in videoconference-delivered CBT for children and adolescents than patients and their caregivers.24 Moreover, a recent review on the therapeutic relationship in teletherapy concluded that adult patients were generally satisfied with teletherapy in terms of the relationship with their therapists, while therapists continued to highlight difficulties in maintaining the quality of the therapeutic relationship.39 Therapists’ tendency to be more critical than their patients has also been reported for traditional face-to-face treatment. For example, two recent studies found that therapists revealed a lower degree of treatment satisfaction following clinic-based CBT than patients and their caregivers.40,41

We also examined factors associated with respondents’ satisfaction with teletherapy at FU. Therapists were less satisfied with teletherapy when treating patients with more stress due to the COVID-19 pandemic (r  =  −.26) and more externalizing behavior problems (r  =  −.26). In addition, therapists reported a more severe impact of teletherapy on treatment satisfaction and the therapeutic relationship for patients with more externalizing behavior problems (r  =  −.20) as well as for younger patients (r  =  .33). This finding is consistent with the study by Bernheim et al.24 who found that therapist ratings of therapeutic alliance and satisfaction with teletherapy were lower in younger children compared to older children and adolescents. A possible explanation may be that limited attentional resources and motor restlessness lead to difficulties in maintaining attention during videoconference-delivered CBT.

Finally, there was a correlation between therapist reported satisfaction with teletherapy and the number of teletherapy sessions (r  =  .19). Having more conducted more teletherapy sessions was associated with higher treatment satisfaction. This finding is consistent with results from a survey among adult patients, which revealed that therapists who held more positive attitudes toward teletherapy tended to have previous experience with teletherapy.8 It is possible that experience with teletherapy increases therapists’ technological proficiency, which may in turn lead to a preference for video treatment.42 Another possible interpretation may be that therapists who were satisfied with teletherapy continued to use teletherapy, while therapists who were dissatisfied returned more rapidly to face-to-face treatment.

Lastly, we examined reasons for not intending to use teletherapy in the future. At T2, 39% of the therapists and 19% of the parents indicated that they do not plan to use teletherapy in the future. The most commonly cited reasons were (a) difficulties implementing child-focused intervention, (b) difficulties maintaining a positive therapeutic relationship, (c) technical difficulties, and (d) concerns about negative impacts of teletherapy on treatment satisfaction. Future research is needed to investigate how and for whom these barriers can be overcome in order to facilitate the long-term implementation of teletherapy in routine care.

Several limitations are worth mentioning. First, we did not assess patients’ self-reported treatment satisfaction due to the large number of young children in our sample. A recent study suggested that adolescents and their caregivers provide comparable ratings of their experiences with teletherapy.26 However, more research is needed to investigate if and in which ways younger patients’ ratings of teletherapy differ from caregiver and therapist ratings. Second, there was a high attrition rate from T1 (n  =  643) to T2 (n  =  228), which could have biased the results. However, as we have noted above, T1 ratings of satisfaction with teletherapy did not differ significantly between parents who completed the T2 questionnaire on treatment satisfaction and those who did not, suggesting that initial satisfaction with teletherapy did not influence parents’ decision to participate in the FU survey.

Finally, it is important to note that patient satisfaction is a necessary but not sufficient indicator of the quality of mental healthcare.37,43 A complete evaluation of the quality of mental healthcare should also include measures of the patients’ symptoms and functioning. Numerous studies demonstrated that face-to-face delivered CBT for children and adolescents significantly reduces patients’ symptoms.44–47 Research on the effectiveness of videoconference-delivered CBT for children and adolescents is still sparse. Existing studies were conducted before the COVID-19 pandemic and used very small samples.16,18,19,22,23 Given the current trend toward remotely delivered psychotherapy in routine care, which is probably not going to wane, further research evaluating the effectiveness of teletherapy for children and adolescents in routine care settings is critically needed.

Conclusions

Results from our first survey27 revealed that the majority of children and adolescents treated in a university outpatient unit received videoconference-delivered CBT following the outbreak of the COVID-19 pandemic. The present FU survey demonstrated that therapists’ and parents’ ratings of satisfaction with teletherapy remained high, even after social distancing restrictions were eased in 2021. Consistent with previous studies,24,39 therapists were more critical raters of treatment satisfaction than were parents. However, the majority of respondents was satisfied with teletherapy, felt that patient satisfaction with treatment was maintained after the transition to teletherapy, and indicated that they intent to use teletherapy in the future. Together, these findings demonstrate that teletherapy is a feasible and well-accepted alternative to face-to-face CBT, especially for older children and those with less externalizing problems. Teletherapy offers several advantages, including an increased ecological validity of treatment and improved access to treatment, which make teletherapy a promising treatment for use in routine clinical care after the COVID-19 pandemic. Future studies should therefore investigate the effectiveness of videoconference-delivered CBT for children and adolescents in routine clinical practice.

Supplemental Material

sj-docx-1-jtt-10.1177_1357633X231157103 - Supplemental material for Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists
Click here for additional data file. (36.8KB, docx)

Supplemental material, sj-docx-1-jtt-10.1177_1357633X231157103 for Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists by Elena von Wirth, Lea Meininger, Julia Adam, KatrinWoitecki, Anne-Katrin Treier, and Manfred Döpfner in Journal of Telemedicine and Telecare

Acknowledgements

The authors thank all families and therapists who participated in the study.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental material: Supplemental material for this article is available online.

References

  • 1.Döpfner M, Adam J, Habbel C, et al. ; TEMPO-Studiengruppe, B-FAST-Studiengruppe. Die psychische Belastung von Kindern, Jugendlichen und ihren Familien während der COVID-19-Pandemie und der Zusammenhang mit emotionalen und Verhaltensauffälligkeiten. Bundesgesundheitsbl 2021; 64: 1522–1532. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Ravens-Sieberer U, Kaman A, Erhart M, et al. Impact of the COVID-19 pandemic on quality of life and mental health in children and adolescents in Germany. Eur Child Adoles Psychiatry 2021; 31: 879–889. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Panchal U, Salazar de Pablo G, Franco M, et al. The impact of COVID-19 lockdown on child and adolescent mental health: systematic review. Eur Child Adoles Psychiatry. Epub ahead of print 2021. 10.1007/s00787-021-01856-w [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Fernandez E, Woldgabreal Y, Day A, et al. Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clin Psychol Psychotherapy 2021; 28: 1535–1549. [DOI] [PubMed] [Google Scholar]
  • 5.Matsumoto K, Hamatani S, Shimizu E. Effectiveness of videoconference-delivered cognitive behavioral therapy for adults with psychiatric disorders: Systematic and meta-analytic review. J Med Internet Res 2021; 23: e31293. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Mazziotti R, Rutigliano G. Tele-mental health for reaching out to patients in a time of pandemic: Provider survey and meta-analysis of patient satisfaction. JMIR Ment Health 2021; 8: e26187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Norwood C, Moghaddam NG, Malins Set al. et al. Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis. Clin Psychol Psychother 2018; 25: 797–808. [DOI] [PubMed] [Google Scholar]
  • 8.Aafjes-van Doorn K, Békés V, Prout TA. Grappling with our therapeutic relationship and professional self-doubt during COVID-19: Will we use video therapy again? Couns Psychol Q 2021; 34: 473–484. [Google Scholar]
  • 9.Beck-Hiestermann FML, Kästner D, Gumz A. Onlinepsychotherapie in Zeiten der Corona-Pandemie. Psychotherapeut 2021; 66: 372–381. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Hoffnung G, Feigenbaum E, Schechter Aet al. et al. Children and telehealth in mental healthcare. What we have learned from COVID-10 and 40,000+ sessions. Psych Res Clin Pract 2021; 3: 3. 2021. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Hopkins L, Pedwell G. The COVID PIVOT – Re-orienting child and youth mental health care in the light of pandemic restrictions. Psychiatr Q 2021; 92: 1259–1270. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Sibeoni J, Manolios E, Costa-Drolon E, et al. Clinical practice during the COVID-19 pandemic: A qualitative study among child and adolescent psychiatrists across the world. Child Adoles Psychiat Ment Health 2021; 15: 68. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Cunningham NR, Ely SL, Barber Garcia BNet al. et al. Addressing pediatric mental health using telehealth during coronavirus disease-2019 and beyond: A narrative review. Acad Pediatr 2021; 21: 1108–1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Pakyurek M, Yellowlees PM, Hilty DM. The child and adolescent telepsychiatry consultation: Can it be a more effective clinical process for certain patients than conventional practice? Telemed J E-Health 2010; 16: 289–292. [DOI] [PubMed] [Google Scholar]
  • 15.American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Telepsychiatry and AACAP Committee on Quality Issues. Clinical update: Telepsychiatry with children and adolescents. J Amer Acad Child Adoles Psychiat 2017; 56: 875–893. [DOI] [PubMed] [Google Scholar]
  • 16.Comer JS, Furr JM, Kerns CE, et al. Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial. J Consulting Clin Psychol 2017; 85: 178–186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.Hollmann K, Hohnecker CS, Haigis A, et al. Internet-based cognitive behavioral therapy in children and adolescents with obsessive-compulsive disorder: A randomized controlled trial. Front Psychiat 2022; 13: 989550. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Nelson E, Barnard M, Cain S. Treating childhood depression over videoconferencing. Telemed e-Health 2003; 9: 49–55. [DOI] [PubMed] [Google Scholar]
  • 19.Himle MB, Freitag M, Walther M, et al. A randomized pilot trial comparing videoconference versus face-to-face delivery of behavior therapy for childhood tic disorders. Behav Res Ther 2012; 50: 565–570. [DOI] [PubMed] [Google Scholar]
  • 20.Prato A, Maugeri N, Chiarotti F, et al. A randomized controlled trial comparing videoconference vs. face-to-face delivery of behavior therapy for youths with Tourette syndrome in the time of COVID-19. Front Psychiat 2022; 24: 862422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Tse YJ, McCarty CA, Vander Stoep Aet al. et al. Teletherapy delivery of caregiver behavior training for children with attention-deficit hyperactivity disorder. Telemed e-Health 2015; 21: 451–458. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Xie Y, et al. A study on the effectiveness of videoconferencing on teaching parent training skills to parents of children with ADHD. Telemed e-Health 2013; 19: 1–8. [DOI] [PubMed] [Google Scholar]
  • 23.Ricketts EJ, Goetz AR, Capriotti MR, et al. A randomized waitlist-controlled pilot trials of voice of internet protocol-delivered behavior therapy for youth with chronic tic disorders. J Telemed Telecare 2016; 22: 153–162. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Bernheim D, Keller F, Fegert JMet al. et al. Akzeptanz der Videotherapie an einer Ausbildungsambulanz für Verhaltenstherapie für Kinder und Jugendliche in Zeiten der Corona-Pandemie. Einschätzungen aus Patienten-, Sorgeberechtigten – und Therapeutensicht [Satisfaction with videoconferencing psychotheraoy in an out-patient clinic of children and adolescents during the corona pandemic]. Nervenheilkunde 2021; 40: 341–347. [Google Scholar]
  • 25.Porter C, Galloghly E, Burbach F. The effective delivery of digital CBT: A service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020. Cogn Behav Ther 2022; 15: E27. [Google Scholar]
  • 26.Mekori-Domachevsky E, Matalon N, Mayer Yet al. et al. Internalizing symptoms impede adolescents’ ability to transition from in-person to online mental health services during the 2019 coronavirus disease pandemic. J Telemed Telecare. Epub ahead of print 2021. 10.1177/1357633X211021293 [DOI] [PubMed] [Google Scholar]
  • 27.Meininger L, Adam J, von Wirth E, et al. Cognitive-behavioral teletherapy for children and adolescents with mental disorders and their families during COVID-19 pandemic: A survey on acceptance and satisfaction. Child Adoles Psychiat Mental Health 2022; 16: 61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Khatib A, Gelkopf M, Kapolnik Eet al. et al. The assessment of effectiveness by therapists of online therapy during the COVID-19 pandemic era in Israel. J Psychother Integr 2022; 32: 83–94. [Google Scholar]
  • 29.Kassenärztliche Bundesvereinigung (KBV). Zertifizierte Videodienstanbieter. Berlin: Kassenärztliche Bundesvereinigung, 2020. [Google Scholar]
  • 30.Döpfner M, Görtz-Dorten A. Corona Belastungsbogen. Unveröffentlicht, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters an der Uniklinik Köln; 2020.
  • 31.Nikolaidis A, Paksarian D, Alexander L, et al. The Coronavirus Health and Impact Survey (CRISIS) reveals reproducible correlates of pandemic-related mood states across the Atlantic. Sci Rep 2021; 11: 8139. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Treier AK, Holas V, Görtz-Dorten A, et al. Impact of the COVID-19 pandemic on children with and without affective dysregulation and their families. Eur Child Adolesc Psychiatry. Epub ahead of print 2022. 10.1007/s00787-022-02106-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Döpfner M, Steinhausen HC. Kinder-Diagnostik-System (KIDS), Band 3: Störungsübergreifende Verfahren zur Diagnostik psychischer Störungen. Göttingen: Hogrefe, 2012. [Google Scholar]
  • 34.Shaffer D, Gould MS, Brasic J, et al. A children's global assessment scale (CGAS). Archives Gen Psychiatr 1983; 40: 1228–1231. [DOI] [PubMed] [Google Scholar]
  • 35.Döpfner M, Plück J, Kinnen C. Manual deutsche Schulalter-Formen der Child Behavior Checklist von Thomas M. Achenbach. Elternfragebögen über das Verhalten von Kindern und Jugendlichen, (CBCL/6-18R), Lehrerfragebögen über das Verhalten von Kindern und Jugendlichen (TRF/6-18R), Fragebogen für Jugendliche (YSR/11-18R). Göttingen: Hogrefe. 2014.
  • 36.LimeSurvey GmbH. https://www.limesurvey.org/de. Accessed 29 March 2021. 2021.
  • 37.Boyer L, Baumstarck-Barrau K, Cano N, et al. Assessment of psychiatric inpatient satisfaction: A systematic review of self-reported instruments. Eur Psychiat 2009; 24: 540–549. [DOI] [PubMed] [Google Scholar]
  • 38.Kinnersley P, Stott N, Peters T, et al. A comparison of methods for measuring patient satisfaction with consultations in primary care. Fam Pract 1996; 13: 41–51. [DOI] [PubMed] [Google Scholar]
  • 39.Cataldo F, Chang S, Mendoza Aet al. et al. A perspective on client-psychologist relationships in videoconferencing psychotherapy: Literature review. JMIR Ment Health 2021; 8: e19004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Viefhaus P, Döpfner M, Dachs L, et al. Treatment satisfaction following routine outpatient cognitive-behavioral therapy of adolescents with mental disorders: A triple perspective of patients, parents and therapists. Eur Child Adolesc Psychiatry 2019; 28: 543–556. [DOI] [PubMed] [Google Scholar]
  • 41.Viefhaus P, Döpfner M, Dachs L, et al. Parent- and therapist-rated treatment satisfaction following routine child cognitive-behavioral therapy. Eur Child Adolesc Psychiatry 2021; 30: 427–439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Von Weinrich P, Kong Q, Liu Y. Would you zoom with your doctor? A discrete choice experiment to identify patient preferences for video and in-clinic consultations in German primary care. J Telemed Telecare. Epub ahead of print 2022: 1–24. [DOI] [PubMed] [Google Scholar]
  • 43.Miglietta E, Belessiotis-Richards C, Ruggeri Met al. et al. Scales for assessing patient satisfaction with mental health care: A systematic review. J Psychiat Res 2018; 100: 33–46. [DOI] [PubMed] [Google Scholar]
  • 44.Battagliese G, Caccetta M, Luppino OI, et al. Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behav Res Ther 2015; 75: 60–71. [DOI] [PubMed] [Google Scholar]
  • 45.Oud M, De Winter L, Vermeulen-Smit E, et al. Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis. Euro Psychiat 2019; 57: 33–45. [DOI] [PubMed] [Google Scholar]
  • 46.Walter D, Dachs L, Faber M, et al. Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: An observational study. Euro Child Adoles Psychiat 2018; 27: 65–77. [DOI] [PubMed] [Google Scholar]
  • 47.Walter D, Dachs L, Fahrwick zum Hagen J, et al. Parent and teacher rated effectiveness of cognitive-behavioral therapy for children and adolescents under usual care conditions in a university outpatient clinic. Child Psychiat Hum Dev 2019; 50: 533–545. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

sj-docx-1-jtt-10.1177_1357633X231157103 - Supplemental material for Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists
Click here for additional data file. (36.8KB, docx)

Supplemental material, sj-docx-1-jtt-10.1177_1357633X231157103 for Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists by Elena von Wirth, Lea Meininger, Julia Adam, KatrinWoitecki, Anne-Katrin Treier, and Manfred Döpfner in Journal of Telemedicine and Telecare

Articles from Journal of Telemedicine and Telecare are provided here courtesy of SAGE Publications

RESOURCES