My Family Tried Little Otter to See if Virtual Therapy Could Really Work for Kids: Here’s What Happened

I’ve been a parent for more than a decade, and in that time I’ve had plenty of practice trying to find the right social, emotional, academic, and medical support for each of my four kids. From finding specialists to coordinating appointments to figuring out how to pay for whatever services are needed, the process has rarely been simple or smooth.

I’m not shy about my belief in the importance of regular mental health checkups, so it came as no shock to my tween when I suggested he meet with a therapist to talk through anything that’s been on his mind lately. However, between work, carpool hours, and extracurricular activities, my family’s calendars are packed, so I knew that virtual therapy would be the easiest way to implement these extra appointments into our schedules. Little Otter is a digital mental health platform that aims to support kids ages 0 to 14 years by offering therapy for kids, couples counseling, child psychiatry, parent support, and a range of additional resources aimed at supporting the whole family.

I tested children’s therapy at Little Otter with my tween for a month and was impressed with its comprehensive platform, the quality of our therapist, and the family-focused approach that encouraged my husband and me to consider how the mental health of each family member impacts the others. While Little Otter offered impressive services, there were some bumps in the road that reminded me that when it comes to raising kids, nothing is ever quite as simple as we hope it will be. Read on to find out more about what we did and didn’t love about Little Otter.

The Little Otter website is clean and intuitive. After browsing the homepage and FAQ, I had the basic information I needed to feel comfortable signing up. I clicked the “Join Now” button in the navigation bar and was taken to a page that outlined the three-step sign-up process, which included creating an account, scheduling a kickoff session, and beginning care.

After clicking the “Get Started” button on this page, I moved through the short series of questions that needed to be answered in order to create an account. These questions started with the most basic, including my name, who I was seeking therapy for (“my child”), and my email address. Once I submitted answers to these questions, which took less than five minutes, I was prompted to create an account using my email address and a password of my choosing. Next, Little Otter asked which state I live in (Little Otter’s services are not available in all states, but the full list of locations is available on the bottom banner of its website) and then more detailed information about my child, including his name, birth date, and the sex he was assigned at birth.

The next question asked if I was affiliated with any of the insurance companies Little Otter works with. I’m not, so I clicked “skip coverage,” which took me to a page that reminded me that purchasing therapy in a bundle would give me a discount. I was then able to view the schedule and choose a time that worked for our family for the kickoff session. The kickoff session is described as a free opportunity to start getting immediate support from a clinician for my child’s big feelings, but I wasn’t sure who I would be meeting with or what the session entailed. The calendar offered many dates and times, and I was easily able to choose one that worked with both my husband’s and my schedules. After selecting a time, I was asked to enter my credit card information to secure our appointment. Though kickoff sessions are free, Little Otter requires a card on file before scheduling so that future appointments can be easily billed.

Once our kickoff session was scheduled, I was redirected to my new, personalized Care Den. The Care Den serves as Little Otter’s patient portal and includes a calendar of upcoming appointments, a message center from which parents can send and receive messages from anyone at Little Otter they are connected with (which at this point was just the care navigator with whom we would have our kickoff session), and access to receipts, billing information, and data and assessments from past sessions.

In the Care Den (and via an email I received after scheduling our kickoff session) I was prompted to complete the Child and Family Mental Health Check-Up questionnaire. The Child and Family Mental Health Check-Up only took about 10 minutes to complete and seemed to be part social history, part medical and mental health history, and part basic assessment. It asked questions focused on my son’s current and past life experiences and who is included in our family, about hospitalizations or physical or mental health conditions anyone in our family has ever experienced, and about any symptoms that might indicate a mental health issue, such as depression or anxiety, that could be impacting myself, my son, or our family as a whole.

While I didn’t know exactly how this information would be used, I was happy to answer what was asked because I imagined that it would be helpful to the care navigator we would meet with during our kickoff session as they helped us choose a therapist.

I was pleasantly surprised to see our family’s overview after I completed the questions. Notably, the overview is broken into three categories, my child, myself, and my family, with different areas of mental well-being, such as emotions, behavior, and social well-being, noted as either “typical” or “concerning.” As a parent, I often wonder what’s normal and what’s not, so it was helpful to see how a mental health provider categorized areas of concern based on the symptoms or experiences I shared.

I received a reminder email about our upcoming kickoff session a few hours before it occurred and had no trouble joining our Zoom meeting at the appointed time. All of our sessions (including the kickoff and our later therapy sessions) took place on Zoom. It felt secure, and, having participated in many virtual meetings, I was comfortable using the platform. The care navigator introduced herself and asked the safety questions I know are typical when interacting with a mental health professional — such as whether I felt my son was in immediate danger or was a danger to anyone else — and then gave an overview of what we would be doing in our session, which included talking very briefly about what brought us to therapy, going over bundle plans and pricing, matching with a therapist, and scheduling our assessment session.

Going into it, I wasn’t quite sure what the kickoff session would entail, but I was surprised that it seemed to primarily be a meeting focused on scheduling and billing, because it is noted on the Little Otter website as time with a clinician to start getting help right away. While this meeting did allow us to get started with Little Otter, we learned that we’d also have to do an assessment before my son would have his first actual therapy session.

After I shared the areas of concern I had for my child, the care navigator confirmed my information, then she went over Little Otter’s policies on things like cancellation and billing. She also asked when we would be available for our assessment and began searching for a date that would work for us.

I was a little surprised that we were already making an appointment for our assessment: I had assumed she would ask if we had any preferences about the type of therapist we would be matched with or offer us some kind of options. When the care navigator started sharing times that a specific therapist had available, I asked her if there were any male therapists available or whether there was a choice of therapists. I shared that I had hoped my son could be matched with a male therapist as he seems to connect well with men and already has a plethora of female care providers (such as teachers and coaches). The care navigator responded that there were no male therapists available in my state and that she was just looking at calendars to see what matched my desire for an after-school time slot. I was disappointed by the lack of male therapists, but the care navigator assured me that all of the therapists available on the platform were excellent at building rapport with kids and highly skilled in the work they do.

After getting our assessment scheduled, our care navigator reminded us that she would send us information on purchasing a therapy bundle, and then our kickoff was done. I was able to see the therapist who had been assigned to our family in my Care Den and appreciated being able to read her bio and learn a little bit about her background before we met with her to begin therapy.

Assessment

I wasn’t sure what format the session would take, so I asked for clarification. The therapist shared that there would first be a parents-only portion of the session, then she and my son would have the opportunity to talk. The therapist started out the session by making sure I didn’t have any safety concerns, then she introduced herself, asked me a bit about myself and my son, and then explained that the assessment was designed to be thorough and would involve lots of questions. As promised, this session included a lot of more in-depth questions about my son’s history, his current challenges and areas of pride, and our family’s background and experiences.

The therapist was a great listener, and it felt like she and I were both engaged and connected the whole time. I felt comfortable answering her questions and sharing the details of my family’s life in large part because of how welcoming and nonjudgmental she was. Once we had completed the parents-only portion of the session, I invited my son to join us and sat with him as he and the therapist started to chat.

After these introductions, I asked my son if he’d rather I stay with him or give him some privacy and he said I could stick around, so I stepped out of sight but within earshot, so that he could get to know his therapist without me hovering. I chose to fold laundry in the hallway — close but not too close — and kept the door slightly ajar so I could step in if he needed me for anything. As the therapist talked my son nodded along, seeming engaged and comfortable. Once they got through the basics, she asked him some light get-to-know-you questions and then told him they could end with a game. After carefully considering the options she offered, he chose “two truths and a lie” and was delighted to stump her with the well-thought-out options he offered her.

Later that evening, I asked my son how he felt about his therapist, and he said that he thought she was nice and asked if there was anything he was supposed to talk about. I reminded him that therapy is his time to talk about the things that are important to him and shared some age-appropriate examples of what I might choose to discuss. After a pause, he started to talk through options for their next game of “two truths and a lie,” which indicated to me that he had no reservations about joining his next session and was possibly even looking forward to it.

Regular Sessions

Subsequently, I was less present in my son’s sessions. I opened the meeting, greeted the therapist, and then came back toward the end of the session to connect and confirm the next appointment. Appointments were 45 minutes long, which felt like the right amount of time for a kid his age. Even though my son was doing virtual therapy from our home, I wanted to give him the same privacy and space he would have if he were seeing a therapist in person, so I did my best to create a quiet space for him to meet with her and avoided hovering or prying. I did check in with him after his session, and he reported that he enjoyed it and that they talked about school and his friends. I had no concerns about my son talking with another adult without me, and I felt confident that their sessions were going well, especially when my son made a point to tell me of things he was thinking of sharing with her or about a good “two truths and a lie” option he had thought of.

Overall, I was really happy with the therapist and the sessions with Little Otter. Though scheduling was a little tricky, we never experienced any technical issues, and my son appeared to be happy to be participating. He was seemingly engaged, and I was glad to see that he had been matched with a therapist who was clearly skilled both in working with kids his age and in creating a therapeutic relationship virtually.

Our family only tested children’s therapy with Little Otter, but the company does offer additional services. Besides teletherapy for kids, Little Otter offers psychiatric services, including medication management, couples therapy, and parent training and support.

While not a formal service, the Care Den also houses a range of helpful resources that I enjoyed browsing as a parent. The articles on the Care Den are displayed in categories, such as “focus and attention,” “worries and anxieties,” “eating,” and “sleep and bedtime.” I especially liked that a selection of articles pertinent to me and based on concerns I’d shared during the checkup were displayed in a “for you” section of the page.

The articles are well-written, and I found myself enjoying some of the information about what sort of behaviors are normal at different ages and about positive ways to navigate some of the challenges we found ourselves facing with each of our kids.

Initial scheduling presented some challenges, but we had an easy time understanding the process and policies around pausing, rescheduling, and canceling therapy appointments or other services. Little Otter has a 24-hour cancellation policy, meaning that clients will be charged for their appointment if they do not cancel or reschedule it at least 24 hours before it is scheduled to begin. This policy is common and fair because therapists won’t be able to fill a slot on such short notice, and Little Otter shares it in multiple places, so I was clear on the policy right from the beginning.

In alignment with its cancellation policy, Little Otter bills for sessions 23 hours before they begin. Unless parents have purchased a bundle, sessions are billed one at a time, so you don’t need to worry about canceling a subscription or managing a membership like with some other therapy companies. The cancellation policy still applies if parents have purchased a bundle. Since bundles don’t expire, parents don’t have to worry about losing a session as long as they remember to cancel or reschedule within the allotted time frame.

I never had any reason to explore switching therapists, but if I had wanted to, I would have felt comfortable reaching out to our care navigator by sending a message through the Care Den. The care navigator remains a contact in your message list, so it’s not difficult to contact them about switching therapists or anything else if you need to. Parents can also reach out to customer service from within the Care Den should they have any questions about billing, scheduling, or anything else they would not talk about directly to their child’s therapist.

Little Otter is a standout among companies that offer online therapy for children. While its self-pay pricing is higher than some competitors, such as Bend Health, it’s not significantly higher than Thriveworks (and may be lower should families choose to purchase a bundle), another popular online therapy company that serves children. Little Otter’s pricing model is very clear, which is not the case with some companies, particularly those that prioritize serving clients with insurance. Little Otter is in network with a shorter list of insurance companies than many of its competitors, such as LifeStance and Amwell, but it does accept some insurance plans.

Little Otter is also able to work with clients in fewer states than some others, such as Thriveworks, Bend Health, and Amwell, each of which offer therapy to clients and families in all 50 states.

Particularly important to parents of younger children, Little Otter is one of the only companies that will serve children who are very young. Grow Therapy requires children to be at least 6 years old to receive its services, and Amwell requires therapy patients to be at least 10.

Overall, my son and I both had a great experience with Little Otter. With clear pricing and an easy-to-follow sign-up process, I felt comfortable getting started, and I was impressed with both the professionalism and skill of the therapist my son worked with.

Little Otter is expensive, though it’s not significantly more than many other high-quality therapy services for kids, especially if parents have the money to purchase a bundle of sessions rather than paying session to session. I had hoped that choosing virtual therapy would reduce the logistical burden of scheduling appointments, but it was harder than I thought it would be to find openings during after-school hours. I was always able to identify a time that would work for our family, but requesting an appointment during the hours my son is not in school did mean we waited longer between appointments.

Though I was initially surprised and disappointed that Little Otter did not have any male therapists in our state, I was quite pleased with the therapist my son worked with. She clearly has a wealth of experience working with families, and I was really impressed with how well she was able to engage with my son virtually. She seemed to be an excellent fit, and if other therapists available with Little Otter are as skilled as she is, parents can trust that their kids will be in good virtual hands during their sessions.

Little Otter was a great fit for my family and for my son. I wonder if families with much younger kids might experience some challenges around engagement and participation with virtual therapy, but if they do, it’s likely that those challenges would be present in any virtual therapy setting and are not unique to Little Otter. The team behind Little Otter has clearly put a lot of thought and effort into building a clean, streamlined platform and into hiring highly skilled therapists. I would recommend Little Otter to other families who want to try a virtual therapy option for their child, who have kids that thrive in a digital environment, or whose schedules necessitate a virtual option.

When it comes to online therapy services, we take our evaluation process seriously. Evaluators for Everyday Health have tested more than 65 online therapy companies in order to find the ones that are best for children, couples, individuals, and families. We know you need accurate information to decide which online therapy services best meet your needs, so we evaluate each company the same way. We vet each company and its business practices, we have interviewed a dozen licensed therapists, and we have surveyed real online therapy users. We also make sure to try out what the company offers by having a professional journalist test each service.

While testing this service, I collected data about:

• The sign-up process
• The intake and assessment experience
• The education, background, and skill of the therapist
• The platform experience and video chat host
• The ease of use of the tech components of the program
• The insurance, billing, payment, and customer service aspects of the service

As a tester, I moved through each step of the process with attention to the factors that matter most to me and other families. I took notes along the way and paused to evaluate each step of the process as a stand-alone component of the program. I also compared my experience with Little Otter to other experiences I’ve had testing or participating in online therapy. I did research to cross-reference what Little Otter offers in comparison to other companies that offer online therapy for kids and in comparison to best practices in children’s therapy and online therapy that have been established by experts in the field.

As a journalist, I have more than a decade of experience collecting data about online services and sharing what I’ve learned with readers. And as a mom of four kids, I have a wealth of experience navigating healthcare and mental health services. These experiences give me a unique lens, informed both by evidence-based recommendations and by the know-how you can only get from real-life experience, through which to evaluate online children’s therapy companies.