(PS9-D89) Lessons Learned Providing CBT for Child and Adolescent Anxiety via Telehealth: A Provider Survey of Barriers, Facilitators, and Quality of Care During the covid-19 Global Pandemic and Beyond

There is a growing body of research supporting the acceptability, feasibility, and efficacy of delivering cognitive-behavioral therapy (CBT) for youth anxiety disorders via telehealth. The Covid-19 global pandemic has led to the rapid uptake of telehealth services. This study describes providers’ perceptions of delivering CBT for youth anxiety via telehealth during the Covid-19 pandemic, with an emphasis on perceived strengths and difficulties. 94 mental health providers completed an anonymous survey. When asked about quality of care, the majority of providers reported no difference in provider-perceived therapeutic alliance (72%), and ability to build rapport (60%). Most providers also reported fewer no shows or cancellation (60%) via telehealth compared to in-person. 49% reported no difference in efficiency of care, with 15% reporting decreased efficiency and 36% reporting increased efficiency. The top three barriers to quality of care via video telehealth were: problems with audio/video quality, difficulty with patient engagement/distractibility, and safety or escape barriers during exposures. The top three facilitators endorsed were: increased access to care, ability to generalize skills to the home setting, and opportunities to complete exposures in-session. Obsessive-compulsive disorder was most frequently endorsed as positively impacting goodness of fit for telehealth, and social anxiety disorder was most often recognized as negatively impacting goodness of fit for telehealth. Providers identified client age as an important factor to consider with telehealth emerging as a better fit for adolescents/young adults than children. Providers also endorsed several safety and avoidance behaviors during exposures to be aware of, including angling the camera away, looking away from the screen, and distracting oneself with technology or other items; as well as strategies to increase engagement in exposures via telehealth including parent involvement, praise, psychoeducation, and motivation interviewing techniques. Clinical implications and ways providers are adapting in-session exposures for telehealth are discussed.