Child and Adolescent Virtual Mental Health Care and Duration of Treatment: Retrospective Cohort Study

Due to public health restrictions, the COVID-19 pandemic required significant changes in the delivery of child and adolescent mental health services. The use of virtual care for balancing access with treatment needs requires a shared decision between clients, caregivers, and clinicians. One aspect for consideration is the length of treatment necessary to achieve desired outcomes and whether it differs by treatment modality. Insights gained from the comparison of treatment duration between modalities may improve our understanding of the effectiveness of virtual care and help to inform clinical decision-making and effective use of resources.

We sought to improve our understanding of how treatment modality impacts treatment duration for children and adolescents accessing Community Mental Health and Addictions services at IWK Health following the rapid implementation of virtual care in March 2020. In this study, we aimed to compare the duration of treatment within episodes of care by treatment modality and determine whether client characteristics, system factors, or time period influenced any associations between treatment modality and treatment duration.

Episodes of care were created using administrative data collected by the IWK Mental Health and Addictions program and used as the unit of analysis. A multilevel mixed-effects negative binomial model and time-to-event analysis were used to model the association between treatment modality and treatment duration, both in visits and days, adjusting for client and system characteristics.

Virtual episodes of care had more visits than in-person episodes between April 1, 2020, and March 31, 2021 (incidence rate ratio [IRR] 1.59, 95% CI 1.38-1.83), and April 1, 2021, and March 31, 2022 (IRR 1.22, 95% CI 1.10-1.35), whereas between April 1, 2022, and March 31, 2023, virtual episodes of care were associated with fewer visits (IRR 0.82, 95% CI 0.74-0.91). Comparable results were seen for treatment duration in days (2020-2021: hazard ratio [HR] 0.64, 95% CI 0.54-0.76; 2021-2022: HR 0.80, 95% CI 0.70-0.90; and 2022-2023: HR 1.10, 95% CI 0.97-1.25). These differences by time period relative to the onset of the COVID-19 pandemic and switch to virtual care were consistent after adjusting for client and system characteristics.

To our knowledge, this is the first study to examine the association between virtual or in-person treatment modality and treatment duration. While initially longer than in-person episodes of care, both in numbers of visits and length in days, over time the average length of episodes conducted mainly virtually had attenuated. These findings may be due to growing comfort with the technology or client factors not adequately captured in administrative data. This information can be valuable to clinicians, clients, and their families regarding expected treatment timelines and aid in informing service planning.