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Consultations: Children and youths

Five principles about how to have good video consultations in your clinical practice

User experiences from children and youths in mental health care.

Click on the boxes below to explore the five principles about good video consultations.

  1. Provide good information about video consultations.
  2. Meet in person at first, or as soon as possible.
  3. Talk about what might be difficult or different in a video consultation.
  4. Check if the youth wants to have a combination of in-person and video consultations.
  5. Take the youth's school day into account when planning consultations. Some youths can join a consultation while at school, in order to minimize the number of missed classes.
  6. As a therapist, schedule consultations for the best possible time, e.g. during the last period of the day so that the youth can leave school afterwards.
  7. Video consultations are often shorter than in-person consultations. Be aware of length and content.

Examples of applying the principle

The youth looks tired. Clock shows 60 minutes.
Long video consultations can be tiring.
The youth is smiling. Clock shows 25 minutes.
Shorten video consultations to e.g. 25 minutes. The youth will not be as worn out afterwards and it can be easier to fit the consultation into a school day.
  1. Provide instruction about the technology and digital meeting rooms you will use.
  2. Make sure the youth and their next of kin receive instruction.
  3. Meet in a safe and user friendly digital meeting room.
  4. Not everyone has the necessary equipment and Internet access (preferably Wi-fi). Look into this before you begin.
  5. Find solutions to potential problems, e.g. continue the consultation over the phone.

Examples of applying the principle

Poor image quality of the youth. Poor Wi-fi icon.
What will you do if technical problems arise? For example, if the Wi-fi is poor or if your video freezes?
The youth is smiling and talking on the phone. Good telephone signal.
One solution can be to switch to a regular telephone call in order to complete the consultation.
  1. A requirement for video consultations is that the youth has access to an appropriate and safe location. Make sure that this is the case.
  2. When video consultations are held at school, make sure that the youth can reserve a soundproof room.
  3. Some youths cannot be at home during consultations. Facilitate this if necessary.
  4. Who is in the room? Do your best to make sure the youth is alone. In some cases a secret code can be helpful when checking if the youth is alone.
  5. Some youths are uncertain if their therapist is alone. Make sure that the youth can see the entire room you are sitting in.

Examples of applying the principle

The youth is sitting on a couch. One brother is sitting on the couch with his cell phone. The other brother stands behind the couch and plays with a balloon.
Where will the youth sit during the consultation? It will be hard to participate if one's siblings are playing in the same room.
The youth sits alone on the couch and smiles.
The youth needs to have a place where they can sit undisturbed.
Three adults are in a meeting room. Two of them are blurry.
The youth might wonder if their therapist is alone.
Three adults are in a meeting room. All three are visible.
Make sure that everyone in the room is visible. (Preferably their faces.)
The youth is sitting on the couch with their hood pulled up. Brother is standing behind the couch and plays with a balloon.
In this example, the youth is signaling that they are not alone by pulling up their hood. In other words, they cannot speak freely.
The youth sits alone on the couch and smiles.
The youth takes down their hood when they are alone again. The signal does not need to be a hood. It can be a natural spoken phrase or unspoken signal. Agree on a secret code with the youth.
  1. Be aware of your body language.
  2. Angle your camera so that it focuses on your face and eyes.
  3. Make sure the youth can hear you. Sit close to the microphone and think about where you sit. Do not sit close to an open window, for example.
  4. Eye contact gives a feeling of closeness. Look into your camera to show the youth you are listening.
  5. Body language and facial expressions are difficult to observe. The screen can make it easier to hide symptoms and how one is feeling.
  6. Dare to be quiet. Reflect about: Why is silence in a video consultation different than an in-person consultation?
  7. Illustrations can make it easier to concentrate and understand the discussion. You can share your screen or point the camera at a whiteboard or notepad.

Examples of applying the principle

Low camera angle of therapist.
This is not a good angle for your web camera. Too much hands and not enough face.
Therapist with face and shoulders.
Place your camera at eye level. Sit close to the camera. Look into the camera.
Therapist and fuzzy speech bubble that says can you hear me?
Make sure the youth can hear you.
Therapist with headset on. Speech bubble that clearly says better now?
Use a good headset. Close programs that make noise. Do not sit close to sources of distracting noises like open windows or ventilation shafts.
Therapist shows a notebook to the camera. Background and notebook are blurry.
Can you read what is on the paper?
Therapist shows a notebook to the camera. Entire picture is clear.
Turn off virtual backgrounds and filters like "blur background".
  1. It is difficult for to be active in an online meeting when you are the only one online and everyone else is sitting in the same meeting room.
  2. The youth should sit with their therapist. Or everyone should join from their own computer.
  3. Hybrid meetings require clear leadership and structure, as well as active involvement of everyone and especially the youth.

Examples of applying the principle

Four adults sit in a meeting room.
This is not a good situation. Multiple health personnel are sitting in the same meeting room and talking amongst themselves. They are not even looking at the youth who is participating remotely.
Two adults sit in a meeting room and look at the screen on the wall. On the screen is a therapist and his patient.
This is better. The therapist is sitting with the youth at a remote location. The meeting is better organized and actively involving the youth in the conversation.

Find five errors in the pictures below of the therapist and the youth.

Therapist and assistant in an office. Assistant is blurry. Therapist is looking down at his hand on the keyboard. Speech bubble with lots of unreadable text.
Solution
Therapist and assistant in an office. Assistant is blurry. Therapist is looking down at his hand on the keyboard. Speech bubble with lots of unreadable text. Five areas are circled in red.
  1. Someone is sitting where the camera cannot see them.
  2. The therapist is talking a lot and quietly.
  3. The therapist is not looking at the camera.
  4. The background is chaotic. Even worse, there is sensitive information written on the notes behind the therapist.
  5. The therapist is typing a lot during the consultation.

The youth is sitting on the couch. Poor Wi-fi. Speech bubble with small, unreadable text. Brother and mom are blurry.
Solution
The youth is sitting on the couch. Poor Wi-fi. Speech bubble with small, unreadable text. Brother and mom are blurry. Five areas are circled in red.
  1. A sibling is playing in the same room where the youth is participating in a video consultation.
  2. Poor Wi-fi.
  3. The youth is sitting far away from the camera or the camera is angled poorly.
  4. The microphone cannot pick up what the youth is saying. They are talking quietly and not saying much.
  5. Someone is following the conversation without the therapist's knowledge. The youth cannot speak freely.

For more information about this article, contact: Monika Knudsen Gullslett

The content on this page is based on findings from the research project Videokonsultasjoner i psykisk helsevern - Brukere og pårørendes erfaringer når videokonsultasjoner overtar for fysiske møter.

The content on this page is sponsored by the Norwegian Centre for E-health Research, Northern Norway Regional Health Authority and Norway Grants.

Relevant publications

This page was last updated:

6 December 2023