thursday,may 13,2004
news
the university daily kansan
7A
Telemedicine focus of research
Therapy treats children who have less access to treatment
By J.T. Mitchum
jmitchum@kansan.com
Kansan staff writer
Psychologists and psychiatrists at the KU Medical Center are looking at the possibility of treating depressed children through data lines, or data circuits that provide access to an intranet.
This new therapy offers possibilities for children otherwise out of range of professional mental healthcare.
"There is such an extreme shortage of psychiatrists and psychologists in communities and getting a visit is in short supply." Eve-Lynn Nelson, coordinator of telemental health research at KU Medical Center, said.
Telemedicine is the name given to the new mode of patient care that brings doctors and patients together via data lines.
together Telemedicine at the medical center was established in 1991, providing a conduit for doctors in small communities to consult with specialists.
Research on the effectiveness of therapy with children through telemedicine's system is in its infancy, but it comes at a time when suicide in young adults is growing in Kansas, according to a study by the Kansas department of health and environment.
That report is consistent with the State Child Death Review board which found suicide had nearly doubled from 1994 to 1998 in ages 15-24.
Suicides are the third-highest reason for youth death behind
"There isn't a doubt in my mind there is a large cross-section of kids undiagnosed in rural communities. Studies show the more convenient to an individual therapy is,the more likely they are to go."
Martha Barnard
KU Medical Center behavioral pediatrics
associate director
violent deaths and car accidents.
Aside from suicide, one in 12 teenagers suffer from a mood disorder at some point.
It's not just distance that is separating children from proper care, it is also insurance coverage, inexperienced health clinicians and a social ignorance about childhood depression, Nelson said.
"There isn't a doubt in my mind there is a large cross-section of kids undiagnosed in rural communities," said Martha Barnard, KU Medical Center behavioral pediatrics associate director.
"Studies show the more convenient to an individual therapy is, the more likely they are to go," Barnard said.
Barnard was one of two clinicians that selected children for the research and evaluated their progress.
Ideally, Nelson would like to see intervention before these disorders get to its worst.
One of the problems preventing this is access to specialized healthcare.
therapy through a video monitor and data lines as they do in person, then access is limited only as far as the intranet can reach.
f children respond as well to
This pilot study was designed to evaluate whether psychological therapy is effective through telemedicine in comparison to traditional therapy.
Barnard said children were treated with cognitive behavioral therapy because of its documented effectiveness at reducing depression.
Barnard said cognitive therapy involved changing a person's perceptions about incidents, which in turn changes the feeling the person responds with.
The behavioral portion of therapy involves teaching exercises to help relieve and eventually avoid feeling depressed.
These exercises are not too unlike meditation, calming and soothing away situations that might lead to bad feelings.
"We needed to set up a model of researching the similarity of effectiveness between traditional therapy and therapy given over ITV." Nelson said. ITV, or Internet tele-video, is the system used in telemedicine to deliver therapy.
The article on Nelson's research appeared in a peer-reviewed journal recently.
Two groups of children, 28 total, diagnosed as depressed by two different clinicians, received one of two types of therapy.
One group was given traditional therapy by a clinician in person, while the other group was given therapy through ITV.
to determine whether school- aged children are depressed, and the children's depression inventory.
Essentially, the effectiveness was the same, Nelson said. Both groups demonstrated a similar reduction in depressive symptoms, which were measured by standardized tests, such as the schedule for affective disorders and schizophrenia, used
Nelson said the number of children tested was small, but emphasized that this was a pilot study meant to see if more research was warranted.
The children have mostly grown up with this technology, so they are more interested in the technology than they would be in normal therapy, Nelson said.
She also said the system seemed to be an icebreaker for the children.
children. But not having an on-site person had some differences.
Therapy with children involves coaching and educating the parents as well, Nelson said.
Where she might normally coach the child during a face-toface session, she found herself coaching the parents more in ITV sessions.
Given the children's responses to therapy, Nelson said she felt much more research was warranted in therapy via telemedicine.
Nelson has delivered therapy through video conferencing systems before, and thought the difference in therapy came in picking up patient cues such as eye contact, but after doing it for a while, she said she can pick up those cues through the camera as well.
The children using the ITV systems were separated in reality by a stretch of hallway at the medical center, but the data lines used were set up to mimic what is available in communities today.
Barnard said there was still uncertainty as to the exact applications of this therapy if proven effective.
— Edited by Nikki Nugent
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