Pros & Cons
Little Otter is a pediatric online therapy company that’s trying to help address this problem by providing accessible mental health care for children ages 0 to 14 and their families. To determine how well it is delivering these services, I signed up to test its parent coaching services. We also surveyed 105 Little Otter users, spoke with therapists that are subject matter experts, and evaluated the company against 54 other online teletherapy companies. Here’s how it fared.
What Is Little Otter?
Little Otter is an online therapy company that provides individual therapy for children, as well as parent coaching, couples counseling, and medication management. It was co-founded in 2021 by Helen Egger, MD, child psychiatry expert and former chair of child and adolescent psychiatry at NYU Langone Health, and her daughter, Rebecca Egger. Rebecca was diagnosed with ADHD at a young age, but she says that the early care she received for her ADHD helped her thrive personally and professionally. She wanted to help other children achieve the same. Today, Little Otter is a rapidly growing company currently serving California, Colorado, Florida, Illinois, Maryland, New York, North Carolina, Pennsylvania, Texas, Utah, Virginia, and Washington DC.
What Services Does Little Otter Offer?
Little Otter provides family-oriented personalized care from licensed mental health therapists and certified coaches. While its main service is virtual child therapy and medication management for children from birth to age 14, it also provides couples and family therapy to people who have children seeking care at the company. The goal of these services is to help address family issues that may be affecting the child’s mental health. It also offers parental coaching—the service I tested—conducted by parenting specialists. These coaching sessions are designed to help give parents supportive tools to modify their behavior to help their child, and also offer a plan to deal with daily parenting struggles. In addition, Little Otter also offers many online resources to complement talk therapy and an interactive, easy-to-navigate interface on the app that makes it easy to connect with your team.
Who Is Little Otter For?
Little Otter can help children and families with the following conditions:
Anxiety Attention difficulties Tantrums Sadness Sleep Aggression Relationship conflicts Parenting issues
“Very few online therapy companies offer services to children, much less providing comprehensive services for the entire family,” says Hannah Owens, LMSW, a subject matter expert. “In this way, Little Otter stands out, even from its competitors who treat children and adolescents individually.”
How Much Does Little Otter Cost?
Little Otter’s prices are clearly laid out on its website. You pay $90 for your 30-minute welcome appointment, then $200 for each visit with your matched therapist. However, the prices for parental coaching sessions and couples and family counseling sessions are not listed. Psychiatry services cost $500 for an initial 75-minute evaluation and $250 for each 30-minute follow-up medication management appointment. These prices are on the high end of the national average cost of mental health services; psychiatry prices are comparable to in-person costs. Still, of the Little Otter users we surveyed, 53% found it to be very affordable or affordable, while 26% thought it was somewhat affordable. This score is average compared to some of the other specialized companies we reviewed, but pales in comparison to bigger competitors in the online therapy field such as Talkspace (which treats teenagers) and Amwell (which treats children and teens). In addition, 72% of respondents felt Little Otter offered good, very good, or excellent value for its price. Seventeen percent, however, said it was not very affordable, and 4% found it not affordable at all—these numbers are very high compared to the majority of the other companies we reviewed, with most “not very affordable” responses landing in the single digits. Similarly, 24% deemed the value for the cost to be fair and 4% felt it was either poor or terrible.
Does Little Otter Take Insurance?
Yes, but only one insurance provider is in-network: Kaiser Permanente. Also, in order for insurance to pay, local clinic pre-authorization is required, which involves an assessment by a clinic. This is disappointing—most other companies we reviewed accepted a variety of plans. For all other insurance holders, Little Otter provides you with a superbill, which you submit to your insurance company for partial reimbursement. Sessions are HSA/FSA eligible, though.
Does Little Otter Offer Discounts?
Little Otter offers two packages to save money. There is a $540 assessment bundle, which includes a 90-minute assessment plus one standard therapy session, as well as a 12-session bundle for $2,040.
Navigating the Little Otter Website
Little Otter’s homepage is warm and welcoming, with cute illustrations, including the otter logo, accompanied by a calming and organic font. You are greeted by a whimsical graphic of plants and flower petals encircling a happy family, with descriptions of who the company serves (“kids,” “parents,” “siblings,” and “grandparents”) incorporated into the design. Next to this, the landing page reads “A whole family approach to kids’ mental health.” In general, the homepage is easy to navigate and features on-brand design, appealing to both children and adults. Many of our surveyed users agreed; 56% found the website to be easy or very easy to navigate, and 37% found it neither easy nor difficult. The homepage clearly outlines the services offered and what to expect when you sign up for the service, including a sample image of the Little Otter app and the functions it performs, testimonials from parents who have used the service, a bio of co-founder Dr. Egger, a list of issues treated, and a list of states where treatment is available. For those who want to skip all the informational pages and get started, the “Join Now” option is highlighted in green, making it easy to sign up. There are also six tabs with multiple drop-down options, breaking down specifics into digestible categories. The first tab, “Our Care,” offers more comprehensive information about the service, how it works, “benefits of an online approach,” pricing details, and an option to join. The second tab, “Meet Our Experts,” goes into detail about members of the care team, explaining the difference between care leads, parent specialists, therapists, and child psychologists. Unfortunately, it only provides bios for three therapists. The third tab is devoted to free resources for parents, including assessments, toolkits, blog posts, a provider referral form, a form to ask child psychologists free questions, and a link to all press. The fourth tab leads to the Little Otter Shop, where journals, posters, cards, and other resources are available for sale.
Does Little Otter Have an App?
Yes, Little Otter does have an accompanying app, which is just as user-friendly as the website. The app simplifies making appointments and communication with team members, retrieving documents and care plans, and accessing supplementary resources. For example, you can book a session with the touch of a button and select available dates and times with your provider. You can also access session recaps and direct-message your therapist in a chat-like format. The app is only available on the App Store for iOS, though.
Signing Up for Therapy at Little Otter
The Little Otter website offers multiple ways to get to the sign-up option, with the most obvious being the “Join Now” tab. When signing up for therapy with Little Otter, you first fill out a brief questionnaire with all of your information. You’ll be asked where you are located in order to ensure treatment is available in your state, and you’ll create an account with your contact information and create a password. Next, you’ll be asked some questions about your child and your concerns for them. There is also a more extensive mental health questionnaire. This questionnaire is a very detailed mental health assessment, similar to the medical survey you fill out at a doctor’s office, asking very personal questions about your child’s mental and physical health. This will help give the therapist a more thorough understanding of your child. Once you’ve completed that step, you can select a time to meet for the initial 30-minute “welcome session” appointment. It’s at this stage that you are matched with a care lead (a clinician who will coordinate your care at Little Otter), based on the time and date you select. I was able to get an appointment the following week. Once you’ve selected your time, you’ll be asked for your payment information to complete the process. I found the entire sign up process relatively easy, as did almost half (46%) of the users we surveyed. Another 46% found it neither easy nor difficult.
How Do Therapy Sessions Work at Little Otter?
Welcome Session
Your 30-minute Zoom welcome session appointment isn’t a therapy or coaching session: it is a meeting with your care lead. During this session, your lead will go over your intake forms and determine the right type of treatment and specialist for your child. Only the parent or guardian attends this session. In my session, we talked about what type of coaching I was interested in, we went over privacy and safety disclosures, and my lead explained exactly how the coaching process worked at Little Otter, giving me some background about the company. It was also a chance for me to ask any questions. Overall, though, the session didn’t feel very thorough and felt almost unnecessary, as I had provided most of this information when I signed up. At the end of the session, though, I was matched with a parenting coach—though once again, I only got a name. No other information about my coach was provided. Again, this felt jarring, but according to our survey, 65% of people we surveyed were satisfied with the therapist options provided. My care lead also scheduled my next two sessions. Because I enrolled in the parent coaching option, there would be no need for my child to be present for any of these. After the session I received a message via the app from the specialist, who rehashed what we went over in our session and also included the information for my next two scheduled sessions.
Assessment Session and Treatment Plan
One week after my welcome session appointment, I met with the parenting coach I was matched with. I was charged for my appointment 24 hours prior to the meeting. During the session, which took place via Zoom, we discussed everything I had already gone over with the care lead the prior week, but in greater detail. We also discussed goals and the coach gave me a broad explanation of how she could help me. It felt a little redundant. I really liked the coach I was matched with and felt like she was well-trained and very thoughtful. However, the session was supposed to take 45 minutes but only ended up taking 25. She told me that during the next session we would go over the treatment plan. After the session I was sent a summary of our session and what to expect next. In the following session, she spent 45 minutes detailing my treatment plan, which was incredibly thorough and divided up into what we would target each week. She read over the plan in the session, explaining each aspect of it. Again, I felt as though I could have done this on my own, instead of having to pay for an entire session in which the plan was read over. After the session I was sent the treatment plan we had gone over. I was also given the option of weekly or bi-weekly sessions.
Weekly or Bi-Weekly Sessions
After the treatment plan is established, sessions may be booked during the Zoom session or afterward via the app. Prior to each of my sessions with Little Otter, I received email reminders, the first of which was an invoice, as Little Otter charges for appointments 24 hours prior. The audio and visual quality of the sessions were flawless, and I experienced no technical difficulties.
Messaging Your Therapist
One great thing about Little Otter is that therapists are very accessible. It is incredibly easy to message them via the app. You can message your therapist from the patient portal in a private chat room and receive asynchronous messages. My therapist was very responsive, responding to messages very promptly during business hours.
Kid/Teen Therapy Sessions
Little Otter offers therapy for children up to age 14. The “non-exhaustive” list of concerns treated includes anxiety, depression, trauma, eating disorders, ADHD, behavioral challenges, OCD, and grief and loss. However, at this time, Little Otter does not assess autism spectrum disorder (ASD). I did not test Little Otter’s child therapy services. If you and your family do choose to partake in child therapy, the second session with your therapist is a 45-minute one-on-one session with your child, though you can attend this session with your child if you and your child so choose. In this session, your therapist will ask your child some intake questions and will discuss your child’s emotional and behavioral patterns and needs with them, identifying goals for therapy. The next session is another meeting between the therapist and the parent or guardian, this time to discuss the therapist’s conclusions as to what type of therapy and mental health services would be right for your child and your family. The fourth therapy session is once again with your child, and this time can be solely a one-on-one between your child and the therapist without a parent or guardian present.
Couples and Group Therapy Sessions
Little Otter also offers couples and group therapy in the “whole family based care” category. This is primarily for parents who are “unable to follow through with parenting strategies that are given due to their own needs,” and also for “adults in the case of parent misalignment, co-parenting support, couples support and individual therapy.” However, this would not be the ideal couples counseling situation for those who are dealing with issues having little to do with children or the raising of a family.
Medication Management/Psychiatry
Although my family and I did not test Little Otter’s psychiatry services, Little Otter also has a stable of child psychiatrists, nurse practitioners, and primary care doctors who can provide medical evaluations and medication management. Psychiatry appointments are recommended every four to six weeks, and sessions generally last between 15 and 30 minutes each. Unlike many other online therapy companies, which generally do not or cannot prescribe controlled substances, Little Otter’s providers can prescribe both stimulants for ADHD and anti-anxiety medication, as well as all types of antidepressants, mood stabilizers, and sleep medications. When considering medication for your child, it is important to remember that many medications that are commonly prescribed for adults, such as antidepressants, carry warnings for children and adolescents as they might increase the risk of suicidality in young people. Seventy-three percent of our surveyed users felt that Little Otter’s psychiatry and medication management services were better than other similar services, and 75% found these services to be good, very good, or excellent overall.
What Happens If I Miss a Session at Little Otter?
Little Otter requires 24 hour’s advance notice of cancellation. It actually charges you for the session 24 hours prior. However, my therapist told me that if I ever needed to cancel within 24 hours, she could probably refund me the money or have it applied to a future session.
Switching Therapists at Little Otter
You can switch therapists at Little Otter at any time by reaching out to your care lead via your Little Otter profile. Your care lead can then manage the transition to the new care team. While I didn’t switch therapists, I would have liked to see the process a little more simplified. Many competing companies do not require you to discuss the switch, which can be awkward. Instead, they make it as simple as clicking a button. Also, they give you a list of options of other therapists you can choose prior to making the actual switch. This is not true of Little Otter. According to our survey, just 43% of those surveyed remained with their initial therapist. Twenty percent of users switched therapists once, an additional 20% two to three times, and 16% four or more times. Forty-two percent reported they were able to select a new provider from an extensive list of therapists, 52% selected from a limited list, and 6% were assigned one.
Pausing or Canceling Therapy at Little Otter
Since there is no commitment at Little Otter if you didn’t pay for a services bundle, you are paying as you go; therefore, pausing or canceling therapy can be as simple as canceling an appointment and refraining from rescheduling another.
Quality of Care and User Satisfaction
After completing an introductory session and two sessions with one of its experts, I was impressed with the company’s attention to detail and the quality of parental coaching I received. Both my care lead and the parenting coach I was matched with seemed incredibly qualified, caring and empathetic. For example, my coach had multiple accreditations, including a master’s degree, board-certified behavior analyst (BCBA), licensed behavior analyst (LBA), and speech-language pathology assistant (SLPA). Compared to other therapists and mental health experts I have worked with in the past, she was equally competent and someone I would have chosen on my own. I don’t think my coach was an anomaly either. Of the users we surveyed, 50% noted that one of the strong points of Little Otter is that the therapists have better qualifications, experience, and specialized training compared to other online therapy companies. And, overall, 79% surveyed were happy with therapist qualifications, rating them as excellent, very good, or good. This satisfaction is true of Little Otter’s child therapy services as well. Another tester of this service reported that her family’s assigned provider was able to quickly develop a rapport with her 10-year-old daughter, and they were able to use her therapy session to openly discuss her feelings and challenges. However, this tester was disappointed in the lack of therapist diversity at the company, and noted that 32% of our user respondents agreed, wishing that there were more Little Otter therapists who had experience working with marginalized communities or who shared their cultural backgrounds. “It is especially important for children to have access to a therapist who understands their daily experience through the lens of their culture, race, and gender identity,” says Owens, “so that they can learn how to talk about their experiences from a young age with an affirming provider who can address any situation from these perspectives.” Overall, 75% of survey respondents had a positive experience with Little Otter, rating its services as good, very good, or excellent, and 70% felt that most or all of their needs were met.
Privacy Policies at Little Otter
At the beginning of each appointment, the therapists explained confidentiality requirements and revealed the situations in which they would have to break it. However, it is difficult to find such information on the website. I ended up finding the incredibly extensive privacy policy via Google. It detailed the personal information the company gathers, how it may be used, when it would disclose personal information, and how it handles data security. Little Otter explains that it collects user data, including protected health information, such as demographic data, payment data, and data gained from its user support services. It also collects your child’s health data, including sex and gender, medical history, and symptoms. It claims it uses this data for “legitimate business purposes,” including but not limited to fulfilling obligations to the user, communicating with the user, enforcing user compliance, and complying with federal and state laws and any judicial proceedings or court orders. It also explains that it shares this information with relevant third parties such as healthcare providers, advisory services, and the government and law enforcement when necessary. However, it does state that it stores information on secured servers and take measures such as encryption to protect its data.
Little Otter vs. Its Competitors
Because Little Otter is a niche online therapy service catering to young children and families, there isn’t a lot of direct competition. None of the other companies we surveyed serve children under 10. “Having access to a service that not only helps but is designed for younger children can be a huge benefit to parents of young kids who are clearly struggling but who have nowhere else to turn,” says Owens. “It’s important to be able to support your child of any age who might be having problems with things like big emotions or behavioral issues, and not have to wait until they are older to address any problems that have arisen.” Of the Little Otter users we surveyed who have used other mental health services in the past, 81% reported a positive experience compared to previous services, with the top reasons being that therapists were more qualified and/or experienced with more specialized training, the website and app were easier to use, and therapists were more culturally supportive with BIPOC and LGBTQIA+ clients (despite our other tester’s complaints in this area). However, there are a few notable places where Little Otter falls short. It is only available in 11 states and Washington DC, excluding most of the country. Additionally, its services are expensive, and without insurance, the price could be prohibitive to those who cannot afford to pay hundreds of dollars out of pocket. Some of Little Otter’s competitors stack up better in these areas. Amwell, for instance, offers pediatric mental health care to children ages 10 and up—so if you have an older child, it might be a more attractive option. For example, Amwell is more affordable. Not only does it accept health insurance, but sessions start at just $109 compared to Little Otter’s $180, making it more affordable for those without insurance or whose insurance won’t reimburse. It is also more accessible, serving all 50 states compared to Little Otter’s 12. Of the users we surveyed, 88% of Amwell users rated the company good, very good, or excellent overall, whereas only 75% of Little Otter users felt this way. If you have a teenager (or a child that has aged out of the services Little Otter provides), Teen Counseling is also a possibility, serving teens 13 and up in all 50 states. It is significantly more affordable than Little Otter; while it doesn’t accept insurance, the average cost per session is at least half the price of Little Otter, ranging from $60 to $90 per week with a monthly subscription. It also has a higher overall rating, with 85% of users considering the service good, very good, or excellent. However, sessions may last just 30 minutes, which is a 15 minutes shorter than Little Otter sessions. Teen Counseling also doesn’t offer medication management at this time.
Final Verdict
In the midst of the current mental health crisis, more online services are needed for younger people. Little Otter offers a great online platform for pediatric mental health support and fills a void in terms of children’s mental health treatment. The website and app are both user-friendly and signing up was relatively easy. As someone who has been in therapy for decades, I was impressed by the parenting coach I was matched with and the quality of care I received. I appreciated the thorough treatment plan and goals put together by the therapist. However, one of the biggest concerns about Little Otter is the cost. I found the initial investment quite staggering. After three sessions and nearly $500, the actual treatment hadn’t even started—in my previous experiences with therapy, treatment began by the second session. However, our other testers found Little Otter’s child therapy services to be age-appropriate and useful; so, if you are looking for online treatment for younger children, especially those under 10, and have the financial means, I do recommend Little Otter’s services.
Methodology
To fairly and accurately review the best online therapy programs, we sent questionnaires to 55 companies and surveyed 105 current users of each. This allowed us to directly compare services offered by gathering qualitative and quantitative data about each company and its users’ experiences. Specifically, we evaluated each company on the following factors: website usability, the sign-up and therapist matching processes, therapist qualifications, types of therapy offered, the service’s quality of care, client-therapist communication options, session length, subscription offerings, client privacy protections, average cost and value for money, whether it accepts insurance, how easy it is to change therapists, overall user satisfaction, and the likelihood that clients would recommend them. We also signed up for the companies in order to get a sense of how this process worked, how easy to use the platform is, and how therapy takes place at the company. Then, we worked with three subject matter experts to get their expert analysis on how suited this company is to provide quality care to therapy seekers.
