Using Technology to Deliver Mental Health Services to Children and Youth: A Scoping Review

Objective:

To conduct a scoping review on the use of technology to deliver mental health services to children and youth in order to identify the breadth of peer-reviewed literature, summarize findings and identify gaps.

Method:

A literature database search identified 126 original studies meeting criteria for review. Descriptive numerical summary and thematic analyses were conducted. Two reviewers independently extracted data.

Results:

Studies were characterized by diverse technologies including videoconferencing, telephone and mobile phone applications and Internet-based applications such as email, web sites and CD-ROMs.

Conclusion:

The use of technologies plays a major role in the delivery of mental health services and supports to children and youth in providing prevention, assessment, diagnosis, counseling and treatment programs. Strategies are growing exponentially on a global basis, thus it is critical to study the impact of these technologies on child and youth mental health service delivery. An in-depth review and synthesis of the quality of findings of studies on effectiveness of the use of technologies in service delivery are also warranted. A full systematic review would provide that opportunity.

INTRODUCTION

Canada’s child and youth mental health system is described as fragmented and underfunded with a significant shortage of mental health professionals (Kirby & Keon, 2006). This is problematic as prevalence rates of psychiatric disorder in community samples of children and adolescents range from 15–25 percent (Parker et al., 2003). Rural and northern communities, in particular, suffer from a severe shortage of psychiatric expertise (Parker et al., 2003; Broder, Manson, Boydell, & Teshima, 2004). Geographic and professional isolation make rural communities less attractive to mental health practitioners, and it is challenging to recruit and retain specialists, who tend to concentrate in larger urban locales (Boydell et al., 2006; Volpe, Boydell, & Pignatiello, 2013). Further, numerous barriers make access to mental health care extremely difficult even in urban environments with no shortage of providers. Most barriers are structural, including cost, transportation, or time constraints. More timely access to mental health care can reduce costs and lessen time constraints (Myers et al., 2010). Consequently, delivery of mental health services using new technologies is a growing area of practice and research interest. Videoconferencing and the Internet are used to deliver child and youth mental health services globally via assessment, consultation, and therapy (Lingely-Pottie & McGrath, 2006; Reed, McLaughlin, & Milholland, 2000) and fill service gaps inherent in remote and rural regions (Cruz, Krupinski, Lopez, & Weinstein, 2005; Elford et al., 2000; Meyers, Valentine, & Melzer, 2007; Meyers, Valentine, & Melzer, 2008; Pesamaa et al., 2004, 2007).

Given the burgeoning use of technologies in child and youth mental health delivery, we require an in-depth understanding of how and what technologies are used. A scoping review of the literature was undertaken to identify the breadth of the peer-reviewed literature in this area, describe key findings and identify gaps and further research and practice opportunities. A scoping review aims “to map rapidly the key concepts underpinning a research area and the main sources and types of evidence available” (Arskey & O’Malley, 2005). Scoping studies are particularly relevant to disciplines with emerging evidence, such as e-mental health strategies, where the existence of few randomized controlled trials makes it difficult for researchers to conduct systematic reviews. In these cases, scoping studies are ideal as a range of study designs in both published and grey literature can be included, addressing questions beyond those related to intervention effectiveness, and generating findings that can complement the findings of clinical trials (Levac, Colquoun, & O’Brien, 2010). Unlike a systematic review, the scoping study does not seek to ‘synthesize’ evidence or to aggregate findings from different studies. A scoping study requires some analytic or thematic framework to represent a narrative account of extant literature; however, there is no attempt to describe the ‘weight’ of evidence regarding particular interventions or policies. This is because the scoping study does not seek to assess quality of evidence and as a result does not determine whether particular studies provide robust or generalizable findings (Arksey & O’Malley, 2005).

METHODS

Best practice in scoping reviews indicates that they should provide an explicit description of their conceptual framework. Consequently, we draw upon an adapted version of Arksey and O’Malley’s (2005) framework, which involves the following phases:

Development of research questions

The overall research questions are: What is the extent of published evidence on using technology to deliver mental health services to children and youth? What is known from the existing literature about the impact of providing services in this manner? What are the gaps in the knowledge base in this burgeoning field?

Location of relevant publications

The scope of the review focuses on identifying evidence-informed uses of technology for mental health service provision. The technologies covered include videoconferencing, Internet-based interventions, email, telephone and mobile phone applications/interventions. Articles were included if published in the English language and in peer-reviewed journals from the year 2000 to December 31, 2012^a. Articles were excluded if they were letters to the editor, dissertations, or focused on technologies used to deliver mental health services to adults, or to deliver mental health information, education and training.

The review was initially broad in scope and range. Keywords were selected to reflect the scope of the work related to videoconferencing, Internet applications and other technologies^b. Searches were conducted with database search engines PsycINFO, EMBASE, and Ovid MEDLINE. The research team developed criteria for review and search terms with a policy stakeholder advisory group and library information specialist.

Screening and selection of publications

The search returned approximately 4387 articles. Article titles and abstracts were first scanned to ascertain article relevance. Two reviewers (KB and MH) independently reviewed a sample of article titles and abstracts (n=200) and then reviewed together to decide upon discrepancies and achieve consensus. Exclusion criteria were applied over three phases wherein articles were read, bibliographies were reviewed and several specialists in the field were consulted with to find additional relevant articles for review. Following this, 126 articles were deemed relevant and full articles were obtained and included in the review (Figure 1).

The literature review examines the use of technologies to deliver mental health services to children and young people and identifies gaps in the findings.