(PS12-97) Providing Cognitive Behavioral Therapy (CBT) via Telehealth to Children: Innovations Based on Psychologists’ Experiences

Due to COVID-19, psychologists were forced to rapidly transition to telehealth. While about 1% of American Psychological Association (APA) clinicians used telehealth for most clients pre-pandemic, 92% used telehealth post-pandemic onset (APA, 2020). However, research has not assessed psychologists’ experiences providing child teletherapy. The purpose of this qualitative study was to explore psychologists’ experiences providing virtual child cognitive-behavioral therapy (CBT) including how they adapted treatment and involved caregivers.

Participants included 18 clinical psychologists (94.44% female, M_age = 42.8, SD = 9.8) who had provided or currently provide CBT via telehealth to children (ages 7-12) for at least 6 months. On average, the psychologists had 9.4 years of experience as a practicing licensed psychologist, and 3.5 years of experience conducting CBT via telehealth. Participants treated children with a variety of diagnoses, with the most commonly reported being anxiety disorders (88.89%), ADHD (88.89%), and oppositional defiant disorder (83.33%). The majority of psychologists reported practicing behavioral parent training (88.89%) and exposure therapy (83.33%), followed by trauma focused CBT (33.33%), and parent-child interaction therapy (33.33%). Participants were interviewed in one of four Zoom focus groups. Auerbach and Silverstein’s (2003) grounded theory approach was used. The transcripts were coded by three coders for relevant text, repeating ideas, themes, and theoretical constructs. Next, two additional, independent raters sorted the themes into theoretical constructs to assess for interrater reliability. Interrater reliability was assessed between coder A and the master list of constructs (R=0.73), coder B and the master list of constructs (R=.73), and coder A and B with one another (R=.67). Overall interrater reliability suggested substantial agreement (R=.71).

Results included the following six theoretical constructs: 1. Transition to telehealth impacts families’ access to care more positively than negatively; 2. Importance of focusing on pre-treatment considerations when conducting CBT via telehealth; 3. Adjusting to increased engagement and management issues that arise during telehealth treatment; 4. Telehealth experience has varied positive and negative impacts on a case-by-case basis on psychologists and children; 5. Psychologists’ attitudes regarding CBT via telehealth were mixed, though more positive than negative; and 6. CBT via telehealth for children is effective and has a long-term future beyond the pandemic. Based on the findings, we generated a theoretical model to help explain how to provide virtual child CBT and develop hypotheses on how to increase focus on engagement difficulties, resources to provide to both patients and providers, and time spent on clinicians’ self-care activities.