Current directions in videoconferencing tele-mental health research

“…standardized clinical outcome measures, instead emphasizing satisfaction as a primary outcome domain (Antonacci et al., 2008; Myers, Valentine, & Melzer, 2008), even when psychometric properties of satisfaction measures were unknown or questionable (for a review, see Mair & Whitten, 2000).”

“…are difficult to replicate (O’Reilly et al., 2007; Ruskin et al., 2004), relatively small clinical within-group change between delivery conditions (O’Reilly et al., 2007), and as noted by others (Antonacci et al., 2008; Greene, Morland, Durkalski, & Frueh, 2008) flawed conceptual and…”

“However, only a handful of randomized, controlled studies of tele-mental health clinical outcomes has been published (De Las Cuevas, Arredondo, Cabrera, Sulzenbacher, & Meise, 2006; Fortney et al., 2007; Frueh, Monnier, Yim et al., 2007b; O’Reilly et al., 2007; Poon, Hui, Dai, Kwok, & Woo, 2005; Ruskin et al., 2004).”

“…of randomized, controlled studies of tele-mental health clinical outcomes has been published (De Las Cuevas, Arredondo, Cabrera, Sulzenbacher, & Meise, 2006; Fortney et al., 2007; Frueh, Monnier, Yim et al., 2007b; O’Reilly et al., 2007; Poon, Hui, Dai, Kwok, & Woo, 2005; Ruskin et al., 2004).”

“CBT may be particularly well suited to tele-mental health in that it is focused on learning principles, is often time limited, and may not be as dependent on the therapeutic relationship than other insight-oriented or experiential therapies, thereby reducing the potential impact of technological interference on therap…”

“Reporting twice on various outcomes of the same study, Nelson et al. (2003, 2006) reported positive and equivalent treatment outcomes between videoconferencing and face-to-face conditions.”

“…health services, clinicians have often reported lower expectations regarding the value of tele-mental health (Austen & McGrath, 2006a; Cruz, Krupinski, Lopez, & Weinstein, 2005; Elford et al., 2000; May et al., 2001; Schopp, Johnstone, & Merrell, 2000; Werner, 2004; Whitten & Kuwahara, 2004).”

“…health services, clinicians have often reported lower expectations regarding the value of tele-mental health (Austen & McGrath, 2006a; Cruz, Krupinski, Lopez, & Weinstein, 2005; Elford et al., 2000; May et al., 2001; Schopp, Johnstone, & Merrell, 2000; Werner, 2004; Whitten & Kuwahara, 2004).”

“…of tele-mental health to determine the reliability of psychiatric interviews and assessments (e.g., Baer et al., 1995; Ruskin et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g., Clark, 1997; Hilty, Servis, Nesbitt, &…”

“With low-quality videoconferencing, the potential exists for the therapeutic alliance to be ruptured or underdeveloped in tele-mental health (Rees & Haythornthwaite, 2004; Rees & Stone, 2005; Schopp et al., 2006; Starling & Foley, 2006).”

“, 2000), there were 63 new published reports three years later (Monnier et al., 2003) and 148 new publications from April 2003 to July 2008.”

“Furthermore, as argued elsewhere (e.g., Greene et al., 2008; O’Reilly et al., 2007), failure to detect a statistically significant difference in outcome does not necessarily indicate equivalence of outcome.”

“However, only a handful of randomized, controlled studies of tele-mental health clinical outcomes has been published (De Las Cuevas, Arredondo, Cabrera, Sulzenbacher, & Meise, 2006; Fortney et al., 2007; Frueh, Monnier, Yim et al., 2007b; O’Reilly et al., 2007; Poon, Hui, Dai, Kwok, & Woo, 2005; Ruskin et al., 2004).”

“Since 2003, studies with older adults have yielded equivalent diagnostic accuracy of dementia and cognitive functioning between face-to-face and tele-mental health modes of service delivery (Cullum, Weiner, Gehrmann, & Hynan, 2006; Hildebrand et al., 2004; Poon et al., 2005; Shores et al., 2004).”

“…significantly disrupt patient satisfaction, accuracy of assessments, reliability of evaluations, or clinical outcomes for patients in a number of settings (Cruz et al., 2004; Hyler et al., 2005; Jones et al., 2006; Kennedy & Yellowlees, 2003; Sorvaniemi, Ojanen, & Santamaki, 2005; Urness, 2003).”

“Most tele-mental health research includes indices of clinical processes such as satisfaction, therapeutic alliance, therapeutic environment, clinical context, and clinician skills (e.g., Bischoff et al., 2004; Foster & Whitworth, 2005; Frueh, Monnier, Yim, et al., 2007; Miller, 2003; Modai et al., 2006; Rees & Stone,…”

“…prior reviews are available (e.g., Frueh et al., 2000; Hilty, Liu, Marks, & Callahan, 2003; Hilty, Marks, et al., 2004; Hyler & Gangure, 2003; Monnier et al., 2003; Norman, 2006), though they predate a major proportion of the total research conducted on this topic, including most clinical trials.”

“, 2004); substance use (Frueh, Henderson, & Myrick, 2005); cognitive-behavior therapy (CBT) for mood and anxiety disorders (Frueh, Monnier, Grubaugh, et al., 2007; Griffiths, Blignault, & Yellowlees, 2006; Himle et al., 2006); cancer patients with adjustment disorder (Cluver, Schuyler, Frueh, Brescia, & Arana, 2005; S…”

“…earlier research that focused on the application of tele-mental health to determine the reliability of psychiatric interviews and assessments (e.g., Baer et al., 1995; Ruskin et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g.,…”

“More recent studies of children and adolescents (Greenberg et al., 2006; Myers, Sulzbacher, & Melzer, 2004; Myers et al., 2006, 2008; Pesämaa et al., 2004; Savin et al., 2006; Sulzbacher et al., 2006) have replicated earlier efforts to establish the acceptability or feasibility of tele-mental…”

“…clinicians generally report being satisfied with videoconferencing technology after using it (Austen & McGrath, 2006a; Foster & Whitworth, 2005; Grealish, Hunter, Glaze, & Potter, 2005; Ruskin et al., 2004; Starling & Foley, 2006; Wagnild, Leenknecht, & Zauher, 2006; Whitten & Mackert, 2005).”

“A review of 27 tele-mental health studies from 1966 to 2003 found that most studies on children and telemental health focused on satisfaction with clinical care, which was typically rated as high, or described novel programs or care (Pesämaa et al., 2004).”

“…et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g., Clark, 1997; Hilty, Servis, Nesbitt, & Hales, 1999), and other case studies (e.g., Cowain, 2001; Glueckauf et al., 2002; Mitchell, Myers, Swan-Kremeier, & Wonderlich, 2003).”

“The research base for tele-mental health-related interventions is slightly more than 50 years old and a number of prior reviews are available (e.g., Frueh et al., 2000; Hilty, Liu, Marks, & Callahan, 2003; Hilty, Marks, et al., 2004; Hyler & Gangure, 2003; Monnier et al., 2003; Norman, 2006),…”

“Further, the field has underutilized standardized clinical outcome measures, instead emphasizing satisfaction as a primary outcome domain (Antonacci et al., 2008; Myers, Valentine, & Melzer, 2008), even when psychometric properties of satisfaction measures were unknown or questionable (for a review, see Mair & Whitten…”

“…focused on the application of tele-mental health to determine the reliability of psychiatric interviews and assessments (e.g., Baer et al., 1995; Ruskin et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g., Clark, 1997; Hilty,…”

“quality of the therapeutic alliance similarly in face-toface versus videoconference service delivery regardless of intervention (Cluver et al., 2005; Morgan et al., 2008; Simpson et al., 2003; Simpson et al., 2005).”

“Although the literature on tele-mental health with ethnoracial minority groups is limited, a systematic framework (based on the DSM-IV outline for understanding cultural issues in psychiatric treatment) has been proposed to address cultural aspects of tele-mental health care (Shore et al., 2006).”

“quality of the therapeutic alliance similarly in face-toface versus videoconference service delivery regardless of intervention (Cluver et al., 2005; Morgan et al., 2008; Simpson et al., 2003; Simpson et al., 2005).”

“…for tele-mental health to address the mental health disparities of isolated communities, particularly with regard to the provision of services where none are otherwise available (Bischoff et al., 2004; Greenwood et al., 2004; Myers et al., 2008; Thomas, Miller, Hartshorn, Speck, & Walker, 2005).”

“…2006; Cluver et al., 2005; De Las Cuevas, Artiles, De La Fuente, & Serrano, 2003; Dobscha, Corson, Solodky, & Gerrity, 2005; Ekblad et al., 2004; Frueh et al., 2005; Greenberg, Boydell, & Volpe, 2006; Greenwood, Chamberlain, & Parker, 2004; Keilman, 2005; Krupinski, Barker, Lopez, & Weinstein,…”

“More recent studies of children and adolescents (Greenberg et al., 2006; Myers, Sulzbacher, & Melzer, 2004; Myers et al., 2006, 2008; Pesämaa et al., 2004; Savin et al., 2006; Sulzbacher et al., 2006) have replicated earlier efforts to establish the acceptability or feasibility of tele-mental…”

“…patient intervention and psychotherapy, assessment and evaluation, medication management, case management, supportive counseling, psychoeducation, and professional supervision and training, as well as administrative and managerial tasks (see Glueckauf & Ketterson, 2004; Godleski et al., 2008).”

“Most tele-mental health research includes indices of clinical processes such as satisfaction, therapeutic alliance, therapeutic environment, clinical context, and clinician skills (e.g., Bischoff et al., 2004; Foster & Whitworth, 2005; Frueh, Monnier, Yim, et al., 2007; Miller, 2003; Modai et al., 2006; Rees & Stone,…”

“In addition, rural service providers face a number of unique challenges, including limited access to specialized training and consultation and limited options for assessment and treatment referral sources (Griffiths et al., 2006; Hilty, Yellowlees, & Nesbitt, 2006; Hilty et al., 2007).”

“Most tele-mental health research includes indices of clinical processes such as satisfaction, therapeutic alliance, therapeutic environment, clinical context, and clinician skills (e.g., Bischoff et al., 2004; Foster & Whitworth, 2005; Frueh, Monnier, Yim, et al., 2007; Miller, 2003; Modai et al., 2006; Rees & Stone,…”

“In addition, rural service providers face a number of unique challenges, including limited access to specialized training and consultation and limited options for assessment and treatment referral sources (Griffiths et al., 2006; Hilty, Yellowlees, & Nesbitt, 2006; Hilty et al., 2007).”

“However, practice guidelines to address these shortfalls are gradually emerging (e.g., Shore & Manson, 2004, 2005; Shore, Hilty, et al., 2007).”

“Since 2003, studies with older adults have yielded equivalent diagnostic accuracy of dementia and cognitive functioning between face-to-face and tele-mental health modes of service delivery (Cullum, Weiner, Gehrmann, & Hynan, 2006; Hildebrand et al., 2004; Poon et al., 2005; Shores et al., 2004).”

“These issues include integrating technology and evidence into practice, collaboration with law enforcement, cross-state licensure or collaboration with certified personnel, standard-of-care issues (including emergency protocols, determination of roles and responsibilities of involved staff, liability for risks of aban…”

“…et al., 2004; Savin et al., 2006; Sulzbacher et al., 2006) have replicated earlier efforts to establish the acceptability or feasibility of tele-mental health for this population, yet concerns remain that this research is primarily descriptive rather than empirical (Greenberg et al., 2006).”

“Data also support the reliability of tele-mental health assessments in this population (Lexcen et al., 2006; Nelson et al., 2004).”

“, 2006); cancer patients with adjustment disorder (Cluver, Schuyler, Frueh, Brescia, & Arana, 2005; Shepherd et al., 2006); mental health practitioner training and supervision (Ekblad et al.”

“…another small study conducted with Native American children and their families (n = 21) found preliminary support for the reliability of clinical assessments using tele-mental health, in addition to adequate acceptability and high satisfaction for tele-mental health services (Savin et al., 2006).”

“So far, many ethical and regulatory issues surrounding tele-mental health service delivery via videoconferencing remain unaddressed (Hyler & Gangure, 2004; Koocher, 2007), and this lack of clarity extends to other electronic means of mental health service delivery as well (for a review of ethical considerations of onl…”

“…50 years old and a number of prior reviews are available (e.g., Frueh et al., 2000; Hilty, Liu, Marks, & Callahan, 2003; Hilty, Marks, et al., 2004; Hyler & Gangure, 2003; Monnier et al., 2003; Norman, 2006), though they predate a major proportion of the total research conducted on this topic,…”

“…PSYCHOLOGY: SCIENCE AND PRACTICE • V16 N3, SEPTEMBER 2009 330 tele-mental health studies could feasibly be designed as randomized, controlled studies, and that CBT for depression delivered to children via tele-mental health was as effective as that delivered face-to-face (Nelson et al., 2006).”

“…et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g., Clark, 1997; Hilty, Servis, Nesbitt, & Hales, 1999), and other case studies (e.g., Cowain, 2001; Glueckauf et al., 2002; Mitchell, Myers, Swan-Kremeier, & Wonderlich, 2003).”

“…‘‘local knowledge’’ that influence referral and support responses, firearm ownership that affects risk assessment and emergency management, and dual relationships or boundary issues in small communities (Alverson et al., 2004; Bischoff et al., 2004; Schopp et al., 2006; Shore, Hilty, et al., 2007).”

“…that all tele-mental health efficacy studies should assess direct and indirect costs associated with this medium of care, and include longitudinal formal cost-effectiveness, cost–benefit, cost-offset, and opportunity-cost assessments (Glueckauf & Ketterson, 2004; Hilty, Bourgeois, et al., 2004).”

“Fortunately, evidence suggests that tele-mental health usually requires little to no additional clinician preparation time compared to a traditional consultation (Aas, 2003) and typically does not require significant modifications to adult protocols (Singh et al., 2007).”

“327 quality of the therapeutic alliance similarly in face-toface versus videoconference service delivery regardless of intervention (Cluver et al., 2005; Morgan et al., 2008; Simpson et al., 2003; Simpson et al., 2005).”

“In a study conducted in Canada, individual patient costs for tele-mental health were lower compared to face-to-face consultations when a comparable number of patients were seen in both conditions (Persaud et al., 2005).”

“…Baer et al., 1995; Ruskin et al., 1998; Zarate et al., 1997), its utility as a consultation, educational, and professional supervision tool (e.g., Clark, 1997; Hilty, Servis, Nesbitt, & Hales, 1999), and other case studies (e.g., Cowain, 2001; Glueckauf et al., 2002; Mitchell, Myers,…”

“Another study compared the cost of videoconferencing with the cost of sending a patient from a remote community for suicide risk assessment (Jong, 2004).”

“Concerns regarding tele-health practitioner experience and credentialing remain, and do not yet have any legal precedent set (Hyler & Gangure, 2004; Jones et al., 2006).”

“…health services, clinicians have often reported lower expectations regarding the value of tele-mental health (Austen & McGrath, 2006a; Cruz, Krupinski, Lopez, & Weinstein, 2005; Elford et al., 2000; May et al., 2001; Schopp, Johnstone, & Merrell, 2000; Werner, 2004; Whitten & Kuwahara, 2004).”

“In general, efficacy studies have focused on general psychiatric services (Rees & Haythornthwaite, 2004) rather than on the delivery of psychotherapy, and most of the psychotherapy studies reviewed have failed to use manualized or replicable interventions.”

“…significantly disrupt patient satisfaction, accuracy of assessments, reliability of evaluations, or clinical outcomes for patients in a number of settings (Cruz et al., 2004; Hyler et al., 2005; Jones et al., 2006; Kennedy & Yellowlees, 2003; Sorvaniemi, Ojanen, & Santamaki, 2005; Urness, 2003).”

“quality of the therapeutic alliance similarly in face-toface versus videoconference service delivery regardless of intervention (Cluver et al., 2005; Morgan et al., 2008; Simpson et al., 2003; Simpson et al., 2005).”

“…psychiatric consultation-liaison services (Hilty, Yellowlees, Cobb, et al., 2006; Hockey, Yellowlees, & Murphy, 2004); deployed military personnel (Grady & Melcer, 2005; Hill et al., 2004; Neufeld, Yellowlees, Hilty, Cobb, & Bourgeois, 2007); and diagnosis ⁄ assessment (Hildebrand, Chow,…”

“…including neuropsychological and competency assessments, diagnosis, and treatment (Brett & Blumberg, 2006; Khalifa, Saleem, & Stankard, 2007; Leonard, 2004; Lexcen, Hawk, Herrick, & Blank, 2006; Manfredi, Shupe, & Batki, 2005; Miller et al., 2005; Myers et al., 2006; Nelson, Zaylor, & Cook,…”

“…knowledge, limited exposure to technology, or education about the equipment) and lack of confidence to manage problems involving technology are the main impediments patients describe in using tele-mental health (Alverson et al., 2004; Shore, Savin, Novins, & Manson, 2006; Starling & Foley, 2006).”

“…al., 2006; Hockey, Yellowlees, & Murphy, 2004); deployed military personnel (Grady & Melcer, 2005; Hill et al., 2004; Neufeld, Yellowlees, Hilty, Cobb, & Bourgeois, 2007); and diagnosis ⁄ assessment (Hildebrand, Chow, Williams, Nelson, & Wass, 2004; Kobak, 2004; Shore, Hilty, & Yellowlees, 2007).”

“…(Antonacci et al., 2008; Frueh et al., 2000; Glueckauf & Ketterson, 2004; Hilty et al., 2003; Hyler, Gangure, & Batchelder, 2005; Kuulasmaa, Wahlberg, & Kuusimäki, 2004; Monnier et al., 2003; Norman, 2006; Pesämaa et al., 2004; Urness, Hailey, Delday, Callanan, & Orlik, 2004; Wootton, 2006).”

“…therapy (Bischoff, Hollist, Smith, & Flack, 2004; Hill et al., 2004; Keilman, 2005; Kuulasmaa et al., 2004); mental health services for the deaf (Austen & McGrath, 2006b; Lopez et al., 2004); substance use (Frueh, Henderson, & Myrick, 2005); cognitive-behavior therapy (CBT) for mood and anxiety…”

“More recently, data suggest that the costeffectiveness of providing traditional face-to face psychiatric consultations in rural areas is four times greater than the cost of tele-mental health consultations (Harley, 2006).”

“…health services, clinicians have often reported lower expectations regarding the value of tele-mental health (Austen & McGrath, 2006a; Cruz, Krupinski, Lopez, & Weinstein, 2005; Elford et al., 2000; May et al., 2001; Schopp, Johnstone, & Merrell, 2000; Werner, 2004; Whitten & Kuwahara, 2004).”

“Additionally, with few exceptions (e.g., Krupinski et al., 2004; Shore & Manson, 2004), these studies typically fail to address the issue of missed appointments or missing data.”

“…adjustment disorder (Cluver, Schuyler, Frueh, Brescia, & Arana, 2005; Shepherd et al., 2006); mental health practitioner training and supervision (Ekblad et al., 2004; Fahey, Day, & Gelber, 2003; Heckner & Giard, 2005; Hilty, Alverson, et al., 2006; Meyer et al., 2005; Walter, Rosenquist, &…”

“Despite these issues, research into rural populations supports the potential for tele-mental health to address the mental health disparities of isolated communities, particularly with regard to the provision of services where none are otherwise available (Bischoff et al., 2004; Greenwood et al., 2004; Myers et al., 20…”

“One report described a successful Australian program that has been in service for 10 years and has provided more than 600 telepsychiatry sessions annually in clinical intervention, professional supervision, and training (Starling & Foley, 2006).”

“Data also support the reliability of tele-mental health assessments in this population (Lexcen et al., 2006; Nelson et al., 2004).”

“…processes such as satisfaction, therapeutic alliance, therapeutic environment, clinical context, and clinician skills (e.g., Bischoff et al., 2004; Foster & Whitworth, 2005; Frueh, Monnier, Yim, et al., 2007; Miller, 2003; Modai et al., 2006; Rees & Stone, 2005; Shores et al., 2004; Singh, Arya,…”

“…safety, cost savings, privacy, and an expanded range of services, including neuropsychological and competency assessments, diagnosis, and treatment (Brett & Blumberg, 2006; Khalifa, Saleem, & Stankard, 2007; Leonard, 2004; Lexcen, Hawk, Herrick, & Blank, 2006; Manfredi, Shupe, & Batki, 2005;…”

“…empirically delineate optimal technical and environmental conditions for tele-mental health consultations, although experiential–based recommendations have been proposed (Cruz et al., 2004; Jones, Leonard, & Birmingham, 2006; Major, 2005; Miller, 2003; Rees & Haythornthwaite, 2004; Urness, 2003).”

“…Savin, Garry, Zuccaro, & Novins, 2006; Staller, 2006); family therapy (Bischoff, Hollist, Smith, & Flack, 2004; Hill et al., 2004; Keilman, 2005; Kuulasmaa et al., 2004); mental health services for the deaf (Austen & McGrath, 2006b; Lopez et al., 2004); substance use (Frueh, Henderson, &…”

“More recent studies of children and adolescents (Greenberg et al., 2006; Myers, Sulzbacher, & Melzer, 2004; Myers et al., 2008; Myers et al., 2006; Pesämaa et al., 2004; Savin et al., 2006; Sulzbacher et al., 2006) have replicated earlier efforts to establish the acceptability or feasibility of tele-mental health for…”

“…empirically delineate optimal technical and environmental conditions for tele-mental health consultations, although experiential–based recommendations have been proposed (Cruz et al., 2004; Jones, Leonard, & Birmingham, 2006; Major, 2005; Miller, 2003; Rees & Haythornthwaite, 2004; Urness, 2003).”

“, 2004); mental health services for the deaf (Austen & McGrath, 2006b; Lopez et al., 2004); substance use (Frueh, Henderson, & Myrick, 2005); cognitive-behavior therapy (CBT) for mood and anxiety disorders (Frueh, Monnier, Grubaugh, et al.”

“…therapy (Bischoff, Hollist, Smith, & Flack, 2004; Hill et al., 2004; Keilman, 2005; Kuulasmaa et al., 2004); mental health services for the deaf (Austen & McGrath, 2006b; Lopez et al., 2004); substance use (Frueh, Henderson, & Myrick, 2005); cognitive-behavior therapy (CBT) for mood and anxiety…”

“Concerns regarding tele-health practitioner experience and credentialing remain, and do not yet have any legal precedent set (Hyler & Gangure, 2004; Jones et al., 2006).”

“…et al., 2005; Greenberg, Boydell, & Volpe, 2006; Greenwood, Chamberlain, & Parker, 2004; Keilman, 2005; Krupinski, Barker, Lopez, & Weinstein, 2004; Meyer et al., 2005; Modai et al., 2006; Morgan, Patrick, & Magaletta, 2008; Morland, Frueh, Pierce, & Miyahara, 2003; Urness, Wass, Gordon, Tian, &…”

“These service or program descriptions include reports in the areas of child and adolescent mental health service delivery (Browne, Reilly, & Bradley, 2006; Nelson, Barnard, & Cain, 2003, 2006; Ryan, Stathis, Smith, Best, & Wootton, 2005; Savin, Garry, Zuccaro, & Novins, 2006; Staller, 2006); family therapy (Bischoff,…”

“Generally speaking, successful tele-mental health services depend on how practitioners and patients adapt to the technology and how they incorporate it into routine use, rather than on technical issues (Kerr & Norris, 2004; Morgan et al., 2008; Sulzbacher, Vallin, & Waetzig, 2006).”

“Fortunately, evidence suggests that tele-mental health usually requires little to no additional clinician preparation time compared to a traditional consultation (Aas, 2003) and typically does not require significant modifications to adult protocols (Singh et al., 2007).”

“…& Arana, 2005; Shepherd et al., 2006); mental health practitioner training and supervision (Ekblad et al., 2004; Fahey, Day, & Gelber, 2003; Heckner & Giard, 2005; Hilty, Alverson, et al., 2006; Meyer et al., 2005; Walter, Rosenquist, & Bawtinhimer, 2004); psychiatric consultation-liaison…”

“Additionally, with few exceptions (e.g., Krupinski et al., 2004; Shore & Manson, 2004), these studies typically fail to address the issue of missed appointments or missing data.”

“The data on tele-mental health with children and adolescents are promising, though controlled trials with this population are lacking (Alessi, 2003; Browne et al., 2006; Savin et al., 2006; Starling & Foley, 2006).”

“…Reilly, & Bradley, 2006; Nelson, Barnard, & Cain, 2003, 2006; Ryan, Stathis, Smith, Best, & Wootton, 2005; Savin, Garry, Zuccaro, & Novins, 2006; Staller, 2006); family therapy (Bischoff, Hollist, Smith, & Flack, 2004; Hill et al., 2004; Keilman, 2005; Kuulasmaa et al., 2004); mental health…”

“, 2006; Hockey, Yellowlees, & Murphy, 2004); deployed military personnel (Grady & Melcer, 2005; Hill et al., 2004; Neufeld, Yellowlees, Hilty, Cobb, & Bourgeois, 2007); and diagnosis ⁄ assessment (Hildebrand, Chow, Williams, Nelson, & Wass, 2004; Kobak, 2004; Shore, Hilty, & Yellowlees, 2007).”

“The data on tele-mental health with children and adolescents are promising, though controlled trials with this population are lacking (Alessi, 2003; Browne et al., 2006; Savin et al., 2006; Starling & Foley, 2006).”

“These studies have generally found that videoconferencing is effective and acceptable to patients [7].”

“LIMITED EDUCATION FOR CLINICIANS/ LEARNING OPPORTUNITIES Limited education, clinical exposure, and hands-on learning in telepsychiatry are significant barriers to expanding use.(8,11,20,27,28,31,35,38,40,47,59,89,104,105,107-110) Telepsychiatry education in medical school and residency is minimal,(8,47,110) with only…”