Little Otter Online Therapy Review

According to the Centers for Disease Control and Prevention (CDC), between 2016 and 2019, approximately 6 million children in the United States were diagnosed with ADHD, 5.8 million with anxiety, and 2.7 million with depression. The rate at which these disorders are diagnosed has also increased over time. However, problems with availability of mental health providers and financial accessibility to mental health services consistently create a barrier to care for children and families in need.

Little Otter takes the lead in breaking those barriers with its vigorous efforts to increase accessibility to mental health care for children ages 0 to 14 in 11 states, making it a truly unique service compared to most online therapy services we reviewed. It also takes a holistic approach that involves the whole family—including parents, grandparents, and siblings.

To evaluate the services provided by Little Otter, we surveyed 105 users of the company, received input from a subject matter expert, and my child and I signed up for therapy services ourselves. Read on to see what we thought of the services Little Otter provided.

What Is Little Otter?

Little Otter was founded in May 2020 by a mother-daughter duo: tech entrepreneur Rebecca Egger and her mother, Helen Egger, MD, a child psychiatrist of 30 years.

The idea for the company emerged after Dr. Egger’s son was diagnosed with a rare autoimmune disease that presented as a psychotic disorder. Because of her career, Dr. Egger was able to use her resources to find him therapy and receive a diagnosis—but at the same time, she recognized her position of privilege. Not everyone is so lucky: In the United States, there are only 9.75 child psychiatrists per 100,000 children ages 0 to 14. The American Academy of Child and Adolescent Psychiatry estimates that the country needs closer to 47 child psychiatrists per 100,000 children. 

Dr. Egger didn’t think it was okay that every child wasn’t getting what her child received, so she did something about it by establishing Little Otter, an online therapy company focused on child therapy and family therapy. It was named after the animal that’s become famous for its social, playful, cuddly demeanor with other otters. The name seemed like a good fit to its founders: they wanted a name that called back to the company’s core values that centered on the impact of family and social connection on mental health—especially in 2020, a year that was full of lockdowns, school closures, and few in-person social connections. 

The company has grown quickly in the two years since its founding, with venture capitalists investing over $26 million in the company this year, which the co-founders say will help them continue expanding their reach to additional states nationwide. The founders also noted they hope to provide national availability by 2023. 

Little Otter is also active on social media, providing free resources and tools one post at a time. 

What Services Does Little Otter Offer?

Little Otter is an online therapy company that offers the following services:

• Teletherapy for children aged 0 to 14
• Parent training and support
• Parent coaching sessions
• Couples therapy
• Individual adult therapy
• Family therapy
• Psychiatric services for children

Who Is Little Otter For?

It’s is for children under the age of 14, parents, and families. The treatment approach is holistic, focusing heavily on how treating the whole family can benefit a child’s mental health. 

The company’s goal is to provide outcome-based, clinically validated treatments for pediatric mental illnesses, including:

• Anxiety disorder
• Depression
• Trauma
• Eating disorders
• ADHD
• Behavior disorders
• OCD
• Grief/loss
• Behavior challenges, such as aggression, tantrums, sleep, attention difficulties, relationship conflicts, and sadness

How Much Does Little Otter Cost?

Little Otter, unlike some of the other online therapy services we’ve reviewed, is not a subscription service. You pay per session, though there are bundles to help cut the cost for users who plan to use this service on an ongoing basis. Prices for Little Otter’s services are as follows:

• $90 for a 30-minute welcome session with your care lead, the clinician coordinating your Little Otter care team
• $200 for one 45-minute session with your assigned therapist
• $680 for a bundle of four 45-minute sessions
• $1920 for a bundle of 12 45-minute sessions
• $500 for an initial child psychiatry evaluation

You can also sign up for the Kelp on-demand chatline with mental health experts for $29.99/month, which includes emotional and behavior guidance and support during business hours. 

All services are charged to the credit card that the company has on file 23 hours before the start of your session. 

Little Otter’s prices and plans are much higher than many of the other online therapy companies we reviewed. And it may be unaffordable to many lower-income American families, especially since it only accepts one insurance plan (more on that below). According to the National Council for Mental Wellbeing, 42% of the population found costs associated with out-of-network mental health care unaffordable, leaving 25% of Americans torn between choosing their mental health and personal needs. And it looks like Little Otter is doing little to rectify this problem.

Does Little Otter Take Insurance?

Little Otter is only in-network with one insurance provider: Kaiser Permanente. In order for Little Otter services to be covered with this provider, though, you will need to get a local clinic pre-authorization before signing up for care.

Your costs for using Little Otter may be covered as out of network, depending on your insurance plan. However, you will need to seek reimbursement yourself with your insurance provider. 

This lack of in-network coverage for Little Otter services is a big drawback, especially since its per-session rates are high and many of the other online services we reviewed do accept insurance when treating minors, including Talkspace. 

“Since cost is such a huge barrier to care, especially mental health care, finding a way to make it affordable to more people in need is a must,” explains Hannah Owens, LMSW, Mental Health Editor at Verywell Mind. “This is especially important when more than one family member needs mental health services, as those costs can be especially prohibitive.”

Does Little Otter Offer Discounts?

If you purchase a bundle of sessions, you will save 15% to 20% on your overall per-session cost. However, many families may not be able to afford the steep up-front costs.

Little Otter has announced plans to bridge the economic gap with a funded partnership with venture capitalists in order to provide financial assistance to families in need. Details about what this assistance will look like, though, are not yet available.

Navigating the Little Otter Website

Little Otter’s website is very user-friendly, offering free assessments, toolkits, informative mental health blog posts, an educational resource shop, and more. 

The homepage is bright and welcoming, with the phrase “A whole family approach to kids’ therapy” prominently displayed next to a picture of a parent and two children with an illustration noting its services for kids, parents, siblings, and grandparents. You can click any of these words, and the site will take you to a specialized page explaining each of those services. 

Scrolling down the homepage, there are clear explanations of how the service works, quotes from patients, and a bio of Helen Egger. Resources are easily found in a drop-down menu at the top of the homepage, which provides access to assessments and tools, Little Otter’s blog, its provider referral form, a resources hub, press information, and a free “ask a psychologist” form. 

Little Otter’s blog provides articles on over 47 categories divided by multiple age groups, exploring topics including child suicide, gender identity, COVID-19, BIPOC families, and more. 

The FAQ page is also easily accessible at the top of the homepage, with an organized list of 48 most commonly asked questions. 

According to our survey, over 56% of users considered the website easy or very to navigate, and 37% thought the site was neither easy nor difficult. 

The company also has a clear mission statement, which is evident from its website. “Our mission is to reimagine children’s mental health care in every way,” the company writes. “The quality of care, the access to help, and the urgency and importance of early detection and counseling.” 

While this mission statement doesn’t focus on diversity, it is clear from the website, its imagery, and the company’s blog that it values inclusion. Little Otter’s blog dedicates four categories to marginalized groups most likely to experience exclusion: Body Image, Gender Identity and Expression, LGBTQIA, and BIPOC Families.

Does Little Otter Have an App?

Little Otter offers a free mobile on-demand mental healthcare app that can be downloaded directly to your smartphone. 

How Do You Sign Up for Therapy at Little Otter?

The sign-up process on Little Otter is reasonably straightforward, though I did find myself frustrated with the mandatory “welcome session” and assigned care lead.  

To begin, you enter your zip code to make sure that the service is available near you. If you are in one of the locations it serves, you’ll be invited to create an account providing basic demographic information about your family. 

Next, you will be asked to take an online mental health assessment, which will help match you with a mental health expert. This assessment questionnaire does not require participation from all members of the family, is short yet thorough, and focuses on each family member’s emotional and behavioral challenges and how they impact the family as a whole. 

Multiple choices are provided to explore an array of challenges such as trauma, bullying, focus and attention, grief and loss, self-esteem, and sensory sensitivities. Some questions explore the impact current challenges have on the family, such as "how is the family coping?" or "have you noticed excessive worry from your child?" This allows the algorithm to make calculations from your responses to determine if the behaviors are typical or a reason for concern.  

Once this assessment is complete, you'll be able to see your results gathered by Little Otter's algorithm that identified concerning behavior compared to adults and children of the same age. Although the algorithm is unable to provide a diagnosis, once you're taken to a customized "Care Den" (a private user portal) at the completion of your online questionnaire, it can reveal if there is a higher risk associated with a mental illness. 

You’ll then be provided with a link to schedule a Zoom welcome session with your randomly assigned care lead the person who coordinates all your family’s care at Little Otter. In your Care Den, which is easily accessible at the top of Little Otter’s homepage, using the login link on your desktop or Little Otter’s phone app, you can access all of your upcoming scheduled sessions, curated family resources, and messaging.

Your Welcome Session

Your sign-up process isn’t complete until after your welcome session. This is a 30-minute Zoom call with your assigned care lead, who matches you with a therapist. Only the primary guardian who is requesting service is required to meet with the care lead during the initial sign-up process.

My 30-minute Zoom welcome session was as expected. I was introduced to my care lead, who seemed as enthusiastic about my decision to join the Little Otter family as we were. In this session, we covered Little Otter’s care philosophy, a little background about the company, the cost of services, insurance, and an introduction to the Little Otter mental health app. This portion of the session felt intentionally scripted, but it was necessary to collect and share key information. Thankfully, my care lead offered periodic breaks to answer my questions, allowing the conversation to feel a bit more natural.

In conjunction with Little Otter’s philosophy, collaboration became the leading theme of our session as the care lead walked me through Little Otter’s mental healthcare process step by step. Before beginning the selection process to match my family with a clinician, I was given the floor to confirm family demographics and cover the results from my completed mental health questionnaire in further detail. After our fairly scripted introduction, I was relieved by the heart-centered and validating feedback I received while sharing my mental healthcare concerns. 

My care lead used Little Otter’s screening tool from the responses derived from my initial sign-up mental health assessment to uncover my daughter’s emotional, behavioral, activity, and social challenges. Without my daughter’s input, this assessment tool, which revealed low to high-risk mental health concerns, was also used to support the matching process with our family therapist, forcing me to take a seat on the passenger side of the selection phase. 

As a member of the BIPOC community, I wanted a culturally competent therapist who shared my faith and would incorporate faith into the sessions. I’m a Black mother, military spouse, and woman of faith, and finding a knowledgeable and equipped therapist to serve my family’s needs was very important to me. Unfortunately, faith-based therapists were unavailable, and therapists specializing in the BIPOC community and the unique struggles of our community were limited.

I refused to accept my suggested therapist blindly without the option to review the therapist's bios, so I requested multiple bios to make the final decision. I eventually settled on the therapist I was offered in hopes of receiving adequate care. Still, because I felt like I had to settle due to the lack of availability and access to therapists of color, I was left questioning the website’s messaging stating it supports diversity and inclusion.

My experience seemed to reflect that of our users. According to our survey of Little Otter users, only 30% were able to find therapist options that matched their gender, identity, and background preferences. In addition, only 20% were able to find a therapist that matched their preferences based on specialties. 

It is true that 65% of our survey respondents were satisfied with the therapist options provided—but only 23% of the respondents are Black. This, of course, highlights the mental health disparities often experienced within marginalized communities. Hopefully, as Little Otter expands, the mental health app and online sign-up process with the assigned care lead will offer a more transparent and hands-on selection process with easy access to therapist bios. 

Despite my frustration with the lack of BIPOC therapist availability, I did feel like I was provided a clear picture of how therapy sessions would go from here in that welcome session. 

How Do Therapy Sessions Work at Little Otter?

After the 30-minute Zoom call with your assigned care lead, all therapy sessions take place via Zoom with the therapist you’re assigned. The therapist provides services to family members who are seeking help. The specific services offered by the therapist are determined after your first session. This is when the therapist will establish what family members need mental health service and the type of treatment, such as couples, individual, or family therapy.

Little Otter offers substantial scheduling flexibility but enforces a structured approach to all therapy sessions. This is how our therapist organized our sessions, all of which were 45 minutes long:

• First session: In this session, our therapist had a one-on-one session with me, although my spouse was welcome to join. We discussed the results of my completed mental health assessment, family medical history, and current mental health challenges. 
• Second session: My daughter had a one-on-one intake session, which was also 45 minutes, with the therapist, although I was allowed to remain present. During this session, my daughter answered a variety of intake questions and expressed her emotional and behavioral challenges.
• Third session: In this session, the therapist shared her findings and suggestions with me on the types of treatment most suitable for my family’s needs.
• Fourth session: This was the first one-on-one therapy session between just my daughter and the therapist.

The first few sessions were filled with intake questions to gather necessary information about my child’s health and wellbeing, as well as our family’s, and to build rapport and understanding between us. Most communication occurred during Zoom sessions or messaging through the private user portal. 

Therapy Sessions at Little Otter

My first 45-minute Zoom session I had with the therapist was within five days of our welcome session. We started with a short introduction, a deeper dive into my completed assessment forms, current challenges, trauma history, and a brief risk assessment to rule out potential safety concerns that may affect me or others around me.

The therapist asked me thought-provoking questions, and showed significant interest and discerning curiosity, allowing me to cover all of our mental health concerns. Questions such as “what does our experience with anxiety look like,” “how often do our challenges with anxiety occur,” “in what situations does it occur,” and “what have we done about it” were carefully inserted into our conversation. 

I quickly realized our chosen therapist was a reasonably good match. Her calm demeanor and careful choice of words displayed her exceptional training and were suitable to support my family’s needs. 

Impressively, I was able to schedule a session for my daughter within 24 hours of my first solo session with the therapist.

During my daughter’s 45-minute session with our therapist, the therapist built trust, bridged a connection, and calmed her anxiety within the first 10 minutes of the session.

The questions were thoughtfully tailored to my 10-year-old’s understanding, so much so that I was able to step away from the session once I realized my presence for emotional support was no longer needed. 

From a distance, I could hear my daughter openly discuss her feelings without a hint of disinterest. The therapist managed to maintain her attention with questions about her relationships and challenges with supportive feedback. Her affirming words complemented the session, providing a confidence boost and the “otter bond” my child needed for support. 

Psychiatry Services at Little Otter 

While I did not test out Little Otter’s psychiatry and medication management services myself, they are available to families that need them.

Prescribers are typically psychiatrists, primary care doctors, or psychiatric nurse practitioners who provide 15- to 30-minute sessions every four to six weeks, though timing and scheduling can be adjusted based on individual children’s or family’s needs. 

Little Otter doctors, psychiatrists, and psychiatric nurse practitioners can prescribe:

• Atypical antidepressants
• Anti-anxiety medication
• Controlled stimulants
• Mood stabilizers
• Sleep medications
• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Of the users we surveyed who used Little Otter’s medication management and psychiatric services, 27% were particularly satisfied with their prescriber’s exceptional responsiveness, availability, and genuine care for their wellbeing. In addition, 19% found their providers were easy to communicate concerns with, and 14% felt that their needs were well respected. 

Overall, 75% percent of our surveyed users found Little Otter’s medication management and psychiatry services to be good, very good, or excellent. In addition, 73% considered the medication management service better than similar services. 

What Happens If I Miss a Session at Little Otter?

Clients are expected to cover 100% of the appointment fee if an appointment is missed or cancelled with less than 24 hours' notice. 

You can cancel an appointment more than 24 hours ahead without penalty though using the appointment booking section of the mental health app or your on your desktop. Another option is to contact your personal care lead or the company directly via phone or email. 

Switching Therapists

Switching therapists with Little Otter was a difficult and awkward process. When you request a switch, you have to do so by reaching out to your care lead, and I experienced a great deal of pushback following my request to change providers. My care lead kept urging me to complete a minimum of four therapy sessions with my assigned therapist before switching. Unfortunately, the switch never occurred. 

This level of pushback is disheartening, especially since we generally didn’t experience any pushback at other therapy companies we reviewed. And if a client is unhappy with their therapist, they should be able to switch if and when they want to. 

“Building a therapeutic alliance is a tenet of successful therapy,” Owens explains, “and if for whatever reason this cannot be done—if you or your child do not like your therapist, if you don’t feel like they are relating appropriately to your identity or experiences, or if you do not trust your provider—switching therapists is absolutely necessary.” 

It appears that many of our survey respondents were unhappy with their first assigned therapist. Twenty percent of the users indicated that they had switched therapists at Little Otter once, 20% reported switching two to three times, and 16% told us they had switched four or more times, which was the highest reported percentage across all of the 55 companies we surveyed for this project. It is unfortunate, then, that the process of changing providers at Little Otter is so challenging.

Pausing or Canceling Therapy at Little Otter

The option to pause therapy sessions is not available at this time at Little Otter, but it is important to note, all of your sessions do not have to be scheduled at the time of purchase. In other words, since it’s pay-per-session, you can stop and continue services at any time.

Canceling therapy sessions at Little Otter can be done in three ways. You can either cancel the appointment using the appointment booking section of the mental health app, contact your personal care lead, or you can contact the company directly via phone or email. All cancellations must occur more than 24 hours before the scheduled appointment to avoid charges. If a bundle of four to12 sessions is purchased, unused sessions are not refundable. 

Still, canceling is a much easier process than switching therapists. Appointments can be cancelled or rescheduled with a simple click of a button in the app, avoiding the unnecessary and time-consuming pushback from the care lead. And since Little Otter is not a subscription, once you’ve cancelled your sessions, you won’t be billed again. 

Quality of Care and User Satisfaction

The quality of care my family and I received was fair. As a military family, we’ve been fortunate to receive quality online mental health services fully covered by our health insurance. Our providers have done exceptionally well in offering services that meet all of our needs and considering our unique and diverse military community. 

Permanent Change of Station (PCS) moves and deployment stress add to the unique trauma associated with the life of a military family. Tack on race and gender-based trauma, and now there’s an even deeper divide that can make finding qualified therapists more challenging.

Unfortunately, my care lead could not honor my request for a therapist who’s qualified to serve members of my community. After acknowledging the importance of my request, I was told my family is more than welcome to discuss our cultural challenges with any of Little Otter’s therapists. My issues were poorly addressed, and the dismissive response without the option to switch therapists left me no choice but to settle with the therapist I was assigned.

Although my therapist with Little Otter offered quality care, I was left wondering if this was the right fit for my family due to my inability to switch therapists until agreed-upon therapy sessions were complete with the assigned therapist.

Eighty-one percent considered Little Otter a better service than companies they’d used in the past for several reasons, such as exceptional cultural support, better qualifications, and an easy-to-use mental health app. 

Still, mirroring my experience, 32% of our survey respondents reportedly want more access to therapists with similar cultural backgrounds and experience working with marginalized groups. And another 16% wish Little Otter gave them access to therapists who accept insurance. Little Otter is currently seeking ways to offer affordable and increased access to therapists for underrepresented communities who need them most. Hopefully, they’ll be able to deliver. 

Privacy Policies

According to the company’s privacy policy, users’ personal collected data is protected on secure servers with a combination of technical, administrative, and physical security safeguards, including authentication, encryption, backups, and access controls in accordance with federal privacy law.

The company makes it clear that there is no 100% guaranteed protection, though, and users are fully responsible for protecting personal data while using the mental health app on their cellular devices. Little Otter also confirms that personal data is recorded and shared with third-party business partners who provide data hosting, customer service, payment processing, and IT services.

Little Otter will share personal data with the government, lawyers, accountants, banks, and auditors if legal matters arise. 

Little Otter vs. Its Competitors

Of the users we surveyed, 81% found Little Otter to perform better than other mental health services they have used in the past. The top three contributors to this outstanding result include therapists with better qualifications, experiences, and specialized training, the easy-to-use app, and culturally supportive therapists. It is crucial to highlight that 67% of our white respondents represent the majority of these results, clearly explaining the contradiction to my experience. This data underscores the necessity of specialized training and culturally supportive therapists as it improves the likelihood of success for the clients.

While our users were generally satisfied, there are things that Little Otter’s competitors do better. For example, Amwell outshines Little Otter with insurance acceptance and affordable services ranging between $109 to $129 per session. It also serves all 50 states with a high 88% user satisfaction rate, ranging from good to excellent, compared to Little Otter, with a 75% user satisfaction rate. However, it only offers services to children ages 10 and above, making Little Otter the better choice for families with younger children. 

Teen Counseling also does not accept insurance or treat young children, though with a monthly subscription ranging between $240 to $400 per month, it is more affordably priced than Little Otter for older children and teens, received an 85% user satisfaction rate, and it is available in all 50 states. Teen Counseling does not offer medication-management services, though, and therapy sessions can be as short as 30 minutes. This ultimately gives Little Otter the edge in terms of quality of care. 

Final Verdict

Little Otter would be a great fit for someone seeking timely help for their young children and families. I appreciated the family-centered approach to treating mental illness by getting everyone involved. It offers a wide range of services for families, including children’s therapy for kids from birth to age 14, couples therapy, parent coaching, and family therapy. 

However, the prices are high and it does not accept insurance. I would have also preferred greater freedom and transparency when choosing a provider, rather than being matched with one by an assigned care lead. I acknowledge Little Otter’s attempt to magnify the importance of diversity and inclusion, but more collaboration with providers from marginalized communities would greatly benefit this platform. 

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. We also worked with three subject matter experts to get their expert analysis on how suited this company is to provide quality care to therapy seekers.