Abstract
Background: Video consultations has been suggested to lower the threshold for child and adolescent mental
healthcare treatment. This study explores how young people receiving child welfare services experience video
consultations in child and adolescent mental healthcare. The study is part of a larger Norwegian study of access to
health services for this target group.
Methods: The study has a mixed methods design including qualitative interviews and a quantitative survey, with
young people receiving child welfare services. The qualitative interviews included 10 participants aged 15–19. The
survey included 232 participants aged 16–24 of which 36 reported having received video consultations in mental
healthcare. The interviews were analysed using thematic analysis. The survey data was presented as frequencies to
clarify the distribution of positive and negative perceptions of video consultation.
Results: The results show that the participants experienced video consultations as more superficial and less binding,
compared to in-person sessions. They raised concerns of the therapeutic relationship, however some found it easier
to regulate closeness and distance. In the survey several reported that their relationship with the therapist got
worse, and that it was much more difficult to talk on screen. Moreover, a large proportion (42%) claimed that video
consultations did not fit their treatment needs overall. However, a minority of the participants found it easier to talk to
the therapist on screen.
Conclusions The study reveals important weaknesses and disadvantages of online therapy as experienced by
young people receiving child welfare services. It is particularly worrying that their criticism involves the relational
aspects of treatment, as children receiving child welfare services often have relational experiences which make them
particularly sensitive to challenges in relationships. This study shows that youth involvement in decision making of
video consultations in therapy has been rare. Clinicians should be aware of these young people’s doubts regarding
the quality of video consultations in child and adolescent mental health care. Further studies should examine how user involvement can be incorporated in video consultations in therapy and how this could improve experiences and
the quality of video consultations.
healthcare treatment. This study explores how young people receiving child welfare services experience video
consultations in child and adolescent mental healthcare. The study is part of a larger Norwegian study of access to
health services for this target group.
Methods: The study has a mixed methods design including qualitative interviews and a quantitative survey, with
young people receiving child welfare services. The qualitative interviews included 10 participants aged 15–19. The
survey included 232 participants aged 16–24 of which 36 reported having received video consultations in mental
healthcare. The interviews were analysed using thematic analysis. The survey data was presented as frequencies to
clarify the distribution of positive and negative perceptions of video consultation.
Results: The results show that the participants experienced video consultations as more superficial and less binding,
compared to in-person sessions. They raised concerns of the therapeutic relationship, however some found it easier
to regulate closeness and distance. In the survey several reported that their relationship with the therapist got
worse, and that it was much more difficult to talk on screen. Moreover, a large proportion (42%) claimed that video
consultations did not fit their treatment needs overall. However, a minority of the participants found it easier to talk to
the therapist on screen.
Conclusions The study reveals important weaknesses and disadvantages of online therapy as experienced by
young people receiving child welfare services. It is particularly worrying that their criticism involves the relational
aspects of treatment, as children receiving child welfare services often have relational experiences which make them
particularly sensitive to challenges in relationships. This study shows that youth involvement in decision making of
video consultations in therapy has been rare. Clinicians should be aware of these young people’s doubts regarding
the quality of video consultations in child and adolescent mental health care. Further studies should examine how user involvement can be incorporated in video consultations in therapy and how this could improve experiences and
the quality of video consultations.
