Baweja Raman, Verma Shikha, Pathak Meenal, Waxmonsky James G
Department of Psychiatry and Behavior Health, Penn State University College of Medicine, Hershey Pennsylvania.
Pennsylvania Psychiatric Institute, Harrisburg, Pennsylvania, USA.
Prim Care Companion CNS Disord. 2020 Oct 15;22(5):20m02743. doi: 10.4088/PCC.20m02743.
The coronavirus disease 2019 (COVID-19) pandemic prevented a group-based partial hospitalization program (PHP) from running in-person care due to social distancing guidelines. However, the crisis also simultaneously increased stress on families while decreasing their desire to hospitalize youth for a nonmedical issue. Hence, the need for a PHP remained high. Health care organizations worked diligently to create a secure telehealth platform (tele-PHP) to be delivered to patients in their home environments. This article describes the development and implementation of child and adolescent tele-PHPs in response to the COVID-19 pandemic. These new programs were started in mid-March 2020, and changes were implemented over the next 3 to 4 weeks. Overall, patients and families have been receptive to behavioral health services delivered through telemedicine. While tele-PHPs are the most plausible solution to continue behavioral health care for these patients, some challenges were observed during this process. Besides procedural and technological challenges associated with creating a virtual setup, other difficulties include variable patient engagement, specific treatment-related challenges, and system-related changes. These challenges are addressed through psychoeducation, provision of online measures to assess treatment outcomes, and efforts to optimize parent engagement prior to treatment initiation for better treatment adherence. Initial experiences during a time of crisis suggest that tele-PHP services can be a viable long-term treatment option in the future during both a disaster and routine times to improve access for those who otherwise cannot take advantage of such services. Long-term effectiveness of these interventions still needs to be explored.
2019年冠状病毒病（COVID-19）大流行，由于社交距离指导原则，导致一项基于小组的部分住院治疗项目（PHP）无法开展面对面护理。然而，这场危机同时也增加了家庭的压力，同时降低了他们因非医疗问题而送青少年住院的意愿。因此，对PHP的需求仍然很高。医疗保健机构努力创建一个安全的远程医疗平台（远程PHP），以便为居家患者提供服务。本文描述了为应对COVID-19大流行而开发和实施的儿童及青少年远程PHP。这些新项目于2020年3月中旬启动，并在接下来的3至4周内实施了变革。总体而言，患者和家庭对通过远程医疗提供的行为健康服务持接受态度。虽然远程PHP是继续为这些患者提供行为健康护理的最可行解决方案，但在此过程中也观察到了一些挑战。除了与创建虚拟设置相关的程序和技术挑战外，其他困难还包括患者参与度不一、与治疗相关的特定挑战以及与系统相关的变化。通过心理教育、提供在线治疗效果评估措施以及在治疗开始前努力优化家长参与度以提高治疗依从性来应对这些挑战。危机时期的初步经验表明，远程PHP服务在未来无论是灾难时期还是常规时期都可能是一种可行的长期治疗选择，以改善那些无法利用此类服务的人群的就医机会。这些干预措施的长期有效性仍有待探索。
