When families begin exploring tele-mental health solutions, sometimes referred to as online therapy for children, they typically have a lot of questions:

• Will my child really connect with a therapist over a digital medium?

• Can we expect similar or better results from working with someone over a phone or computer versus in an office?

• Does this really improve our ability as caregivers to access care and collaborate with our mental health providers? 

All of these questions can be considered facets of a more fundamental one about online therapy:

Does online mental health care work for children and families?

Today, we’re excited to share the initial results of Little Otter’s work with children and families. As you’ll see, this early data shows that online therapy does offer measurable benefits for children - even very young children - and their families.

In this article, you’ll also learn about the context of our work; that is, the early childhood mental health crisis, and the impact of the COVID pandemic on the use of virtual mental health care and early childhood practice.

If you have any questions as you review this early summary of our experiences, research, and data, please don’t hesitate to reach out to hello@littleotterhealth.com. 

The State of Child and Family Mental Health in 2021

Children and families were living through a mental health crisis even before COVID-19. Studies show that:

• One in five children have an emotional, behavioral, or developmental disorder. This is true for children aged 0-5, as well as for older kids. 

• Families wait, on average, 8-16 weeks to access mental health care.

• About 70% of the counties in the United States do not have one child psychiatrist.

• Approximately 80% of children don’t receive the mental health care they need.

It’s worth noting that even kids who do receive mental health care often do not get evidence-based care, or in the case of early childhood mental health, the kind of specialty care that they need. And let’s be clear: when it comes to mental health, early detection and intervention matter.

Complex factors including socioeconomics and mental health stigma combine with logistical considerations such as access to nearby child mental health providers and scheduling challenges to make it extremely difficult for families to access the care they need.

We cannot solve this child mental health crisis simply by training more providers. Nor will current approaches be able to scale to meet the mental health needs of children and families. 

We have to bring together clinical and scientific expertise with technological expertise to make innovative changes in this area.

To improve access to mental health care, Little Otter is pioneering a new approach that leverages technology. We blend digital tools, data science, and top-tier mental health providers to streamline diagnostics and seamlessly connect families to providers. This enables Little Otter to deliver high-quality virtual pediatric mental health care at scale, via our family and child mental health app.

COVID’s Impact on Early Childhood Mental Health

As we now know, COVID-19 has exacerbated the existing global child mental health crisis. In fact, early studies show that COVID’s impact on child and family mental health has been significantly negative. 

In a joint statement released in October 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association called this a national emergency in child and adolescent mental health.

Research shows that the pandemic intensified the rates of childhood mental health concerns and suicide risks:

• Mental health-related emergency department visits for children aged 5-11 and 12-17 increased by 24% and 31%, respectively.

• Early 2021 saw a 50 percent increase in emergency department visits for suspected suicide attempts among girls 12 to 17 years old.

• More than 140,000 children have lost a primary and/or secondary caregiver to COVID-19. Youth of color are disproportionately represented in this group.

COVID-19 Accelerated a Shift to Virtual Mental Health Care for Children and Families

When the COVID-19 pandemic reached the US, none of us could have guessed the huge transformation in our lives. Almost overnight, providers and families had to learn how to use virtual services, and the vast majority of mental and behavioral health care and intervention services moved to remote delivery.

Today, families and providers are both asking the questions, “Does online mental health care work? And is it here to stay?”

Based on the early data we’ve gathered in our work at Little Otter, online care for childhood mental health works. There’s growing evidence that pediatric mental health care delivered through a virtual platform like Zoom is as effective as face to face care for emotional and behavioral challenges. 

At Little Otter, 85% of our families and kids have moved from clinical to subclinical in their assessments after interacting through child mental health app.

Even in relatively short periods, like 6 weeks, we’ve seen real improvement in emotional and behavioral challenges. 

In our clinical work, we’ve also found that access to care and support strongly impacts how families perceive the challenges that are impacting their children and the family as a whole. Please bear in mind that this is just the beginning of our research, and we look forward to releasing more data and research in the months and years to come.

Another study looked at the efficacy of internet-delivered PCIT, or Parent-Child Interaction Therapy. That study showed that in the Internet-delivered group, there was a higher level of “excellent” responders who were also able to sustain gains over a 6-month period. Said differently, virtual delivery seems to be more effective than in-person mental and behavioral health care in some cases. Learn more about how telehealth services support your family’s wellness.

5 Unique Benefits of an All-Virtual Mental Health Care Approach

Years ago, many mental health providers said virtual care would never work. Today, early research indicates that virtual care has the potential to actually work better.

In clinical work, our team has shared a few benefits of an all-virtual care approach:

1. Access

First and foremost, virtual delivery of mental and behavioral health care means more access to care for more families. A provider doesn’t need to be within driving distance of a family to help them. With digital delivery of mental health care, families can access expertise that simply isn’t available in their local communities. Digital delivery also means it’s easier for families to find and connect with providers who don’t have a waitlist.

Another aspect of accessibility is cost. In-person delivery of care isn’t necessarily more affordable; in some cases, a virtual approach means the family doesn’t have to pay for a provider to travel to them.

Finally, digital delivery helps reduce the pain of scheduling, as children and caregivers can join a session remotely from work, school, or the comfort of home.

2. Parent participation

In our work delivering mental health solutions digitally, we’ve found increased rates of engagement, in part because it’s much more convenient for families to participate when care is delivered virtually. After all, there’s no need to get babysitters or leave work early.

One member of our team reported that about 90% of consultations with two parent families now include both parents. Before the pandemic, this same clinician reported that about 25-50% of consultations had both parents present. 

This increase in two-parent participation, especially the increased participation of dads, meant that both parents had first-hand experience with the clinician. It also meant that both parents were able to share their perspectives. All relevant adults - parents, grandparents, other caregivers, and clinical providers - were able to collaborate more effectively and have a better understanding of what the child needed.

As a result, these families experienced much greater progress, more quickly. At the same time, the clinician was able to more quickly understand the context of the family and the parents’ experiences. 

3. More naturalistic, realistic understanding of the child’s environment

Virtual care also has the benefit of occurring within the child’s natural environment. In many cases, clinicians are able to meet with the family from the comfort of their home. They can see the child’s room, their toys, and the space where they live. 

Seeing children in their natural setting can provide a more realistic view of who they are and the family dynamics than what’s evident in an office.

This was also helpful for observing the child in a school setting. Instead of going into schools physically and being an unknown presence in the classroom, the clinician can observe unobtrusively via a video conferencing tool. This can occur in classrooms, playgrounds, after school care, and beyond. 

The child doesn’t know they’re being observed, so the clinician can see the authentic interactions and experiences, without a filter.

4. Accurate information via audio and video content

Part of Little Otter’s approach to virtual care is making space for parents and caregivers to share audio and video content when appropriate. In most cases, our clinicians have found that audio and visual recordings are more helpful and more accurate.

Challenging situations aren’t always predictable. When a clinician is restricted to an hour of observation, they may or may not be able to witness the mental or behavioral challenge firsthand. 

With audio and video content, parents and caregivers can record both positive interactions where the child is thriving, and the challenging situations in all their glory. This can provide the clinician with a more holistic picture of the family’s experience, particularly in those very difficult moments.

5. More self-reflection due to audio/video content

The presence of audio and video recordings also seemed to inspire more self-reflection and self-awareness in parents and caregivers. Admittedly, rewatching or re-listening to these very tense and challenging situations can be difficult. 

That said, the payoff, so far at least, seems to be significant. Parents can see what they were feeling, what they were triggered by, as we go through the experience together.

In many cases, this was more effective than a review or debriefing without the recording.

In Conclusion

It’s important to define when virtual approaches can work, and when they can't. Virtual approaches aren’t a good fit for every type of child mental health intervention, or for every family.

However, when a digital approach is appropriate, tele-mental health solutions can and do work for children and families.

With Little Otter’s digital mental health platform for children and families, we’ve created an entirely virtual, parent-centric care approach that delivers care, handles scheduling, and offers messaging and audio/video sharing. We’re currently working with children 0-14 and their families. 

Because we're taking care of a family and focused on relationships, we offer child and adolescent therapy, as well child and adolescent psychiatry if needed. We also offer parent-child work, family therapy, and we even work just with the grownups on couples counseling. By bringing our expertise in child and family mental health together with industry-leading technology, we’re able to scale and serve more families in the US and beyond.

In addition, we’re committed to contributing to a new generation of knowledge, so we are collecting data and outcomes at every step. This is a first look at our research and the results of our clinical work at Little Otter so far. We’re looking forward to releasing more data and research in the months and years to come.

If you’re interested in online mental health care for your family, register for Little Otter for free here: