What Parents Need to Know About Little Otter Therapy

At first glance, it appears that the online therapy service Little Otter has thought of everything when it comes to parents and caregivers navigating their children’s mental health. With an easy-to-use website and an accessible care team, Little Otter makes it easy to request resources or ask questions even outside of scheduled appointment times. 

Key Specs

• Price: One-time fee of $90 initial for the welcome session; $540 for an assessment bundle; $2,040 for a 12-session bundle; $500 assessment with a licensed psychiatrist. $250 per session with a psychiatrist
• Is Insurance Accepted? Only accepts Kaiser Permanente. All other providers are out-of-network
• Types of Therapy Offered: Children’s therapy, couples therapy, family therapy, psychiatry
• Communication Options: Live video call
• HIPAA Compliant? Yes
• Is There an App? Yes
• Accepts HSA or FSA? Yes
• Prescriptions Available? Yes
• Billing Cadence: Session bundles

Pros & Cons

Pros

• Website is user friendly
• You can message your care team at any time
• Care team responds promptly to messages
• Clinicians listen attentively to concerns
• Clinicians offer helpful insights right away
• Invoices and receipts are sent directly to your email so it’s easy to keep track of payments

Cons

• Unexpected price changes
• Only accepts one insurance
• Services are expensive
• You can’t choose a therapist based on web bios
• Psychiatrist availability is mostly during school hours, so it's difficult to schedule appointments for younger kids

One in six U.S. children between the ages of 2 and 8 has a diagnosed mental, behavioral, or developmental disorder. But according to a Behavioral Health Report created by Milbank Memorial Fund, “not a single state in the country has an adequate supply of child psychiatrists, and 43 states are considered to have a severe shortage.”

Little Otter is trying to change that by being a comprehensive platform for pediatric wellness and mental health. It offers personalized, virtual child and adolescent mental health care, in addition to couples therapy, family therapy, and parental coaching for families of kids receiving care. I was immediately drawn to the company’s messaging services and the layout of its website, and I opted to review Little Otter by signing up for its services. We also surveyed 105 users and worked with three subject matter experts to evaluate the platform against 54 other online therapy platforms. Here’s how it fared.

What Is Little Otter?

Little Otter, which went live in May 2021, was founded by Helen Egger, M.D., and her daughter, Rebecca Egger. Little Otter offers customized mental health options that treat the entire family, rather than just the individual child. There is an app that allows families to track progress, with daily access to your care team when questions, concerns, or schedule changes arise. Little Otter offers digital resources, including a blog with articles and insights from its specialists. With an easy-to-navigate website and app, Little Otter makes it simple to find a provider, schedule sessions, and communicate with your care team. It provides session recaps and resources to make it easy to stay on top of your family’s “care journey.” 

As both a woman-owned and mental health professional-owned company, Little Otter stands out among startups with similar goals. Dr. Egger has over 30 years' experience in the field and was previously the division chief for child psychiatry at Duke University School of Medicine as well as chair of the department of child and adolescent psychiatry and director of the Child Study Center at NYU Langone Health. This past year, Little Otter acquired wellness company Little Renegades. It has raised nearly $27 million in funding to date. 

What Services Does Little Otter Offer?

Little Otter offers the following types of therapy 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

Currently the website only lists the cost of therapy sessions, but it does offer sessions with a psychiatrist who has the ability to prescribe medication.

If parents or caregivers are interested in their own sessions separate from their child, they can also purchase a bundle for themselves.

Who Is Little Otter For?

Little Otter can help children between the ages of 0 and 14 experiencing the following:

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

When a child receives therapy at Little Otter, the company can also help the child’s family through parenting-focused couples therapy, family therapy, and parent coaching. 

How Much Does Little Otter Cost?

Little Offer lists its costs directly on its website FAQ page. As of November 2022:

• An initial welcome session is $90. 
• From there, patients can purchase a $540 assessment bundle, which includes a 90-minute assessment and one standard therapy session, and/or a 12-session bundle for $2,040.
• Psychiatry sessions are $250 per session.

Of the users we surveyed, 56% said that they found Little Otter services to be affordable or very affordable.

Does Little Otter Take Insurance?

Little Otter only accepts one insurance company: Kaiser Permanente. 

If you do not have that plan, you must pay out of pocket, in full, prior to each session. The downside of this is that even if a family has the option for partial or full reimbursement from their insurance, they would still be required to pre-pay for their appointments. This excludes families who are unable to front the $500+ cost of initial services.

Does Little Otter Offer Discounts?

There are no promotions or discounts that I was made aware of or that were publicized on the website. 

Navigating the Little Otter Website and App

Arriving on the homepage, you immediately see the phrase “A whole family approach to kids’ mental health” next to a picture of a parent with two smiling children. 

A blue-green “get started” button is visible underneath a blurb explaining Little Otter’s services. Scrolling down the page, there are sections describing the company’s approach in more detail, a review from a satisfied client, a biography of founder Dr. Helen Egger, and an explanation of “How Little Otter Works” with the steps for signing up for and receiving services. 

Buttons to “get started with your personalized care plan” and “join our care family” are included throughout.

I was immediately impressed with the user-friendly layout of the website. It felt like all of my questions were answered before I had the chance to ask them. Pricing was listed clearly on the FAQ page and the mission of the company made me feel like I was on the right track.

There are multiple headers that link to other pages, including a FAQ page, a blog, and a page with additional resources such as an option to submit a question to an “Ask a Psychologist” section.

Does Little Otter Have an App?

Little Otter does have an app, which provides all the information that can also be accessed online via the patient portal. Patients can schedule sessions and connect to their care team via the app. The app can be downloaded via your device's app store.  

How Do You Sign Up for Therapy at Little Otter?

At the top of the homepage is a “join now” button. You have the option to immediately sign up for your first appointment, or you can choose to complete a free family health assessment, which I did. The assessment provided some feedback as to what my family might need in terms of Little Otter’s services. This included links to online resources and the option to book a welcome appointment to learn more.

After completing an intake questionnaire, which asked questions about my family and our child, including behavioral concerns, I was prompted to provide payment information. I was not asked any questions about the type of therapist I would like for my child, including gender and age. I was matched with a member of the team for my welcome session, which was scheduled for the following week. 

As soon as I signed up I had access to a private user portal that was easy to navigate, and allowed me to send messages to my care team, check my appointment schedule, and view family resources like articles and blog posts.

Little Otter begins its care journey with a welcome session. During this half hour session, a social worker speaks with the patient’s parents or caregiver(s) to assess what the family is concerned about, and what they hope to get out of therapy. 

At the end of my welcome session, the social worker offered us two different options: To start our child with individual therapy sessions, or a psychiatric assessment, which would consist of one 75-minute session followed by a 30-minute follow up. 

Matching With a Therapist at Little Otter

I didn’t know quite what to expect or who I would be seeing for my initial welcome session, but my spouse and I had a 30-minute session with a team member who walked us through what Little Otter can offer and asked us questions about our needs. At the end of the call she scheduled a psychiatric assessment for us and our 5-year-old son. We did not choose the doctor ourselves but were assured that they would be the right fit for our family. When I asked about whether the appointment or its follow-up would be included if I purchased a package bundle, the care team member said she did not know.

We weren’t thrilled with the availability offered for the 75-minute assessment. Our child is in kindergarten and there were no options for an appointment outside of his school day, so we had to schedule a morning appointment nearly two weeks later, and take our son late to school that day. We didn’t love the idea of interfering with his routine, but we knew this was an important step to take. 

Our psychiatrist was not listed on the website and we did not have a bio for her. Lucky for us, she immediately demonstrated that she was a good fit for our family. She was warm and patient as we outlined our concerns, and she began her conversation with our son using some personal information, asking him about his pet lizard and his younger brother. 

Founder Rebecca Egger has said, “We’re really focused on understanding each family’s unique story.” It did feel like our care team wanted to understand the needs of the entire family.

Users surveyed seemed to agree with us. Sixty-five percent of them reported that they were satisfied with the provider options listed on the website, and 79% of surveyed users reported that their therapist’s qualifications were good, very good, or excellent.

How Do Therapy Sessions Work at Little Otter?

As noted above, all new patients are required to start with a 30-minute welcome session with a care coordinator who will offer feedback and a recommendation as to what type of appointment should come next. 

From there, patients can opt for general therapy appointments or choose to have a psychiatry assessment. 

Messaging Your Therapist

I opted not to download the app so I messaged our care lead directly through my patient portal on my laptop. When she responded via the patient portal I would receive an email with a link to her message, where I could then respond within the portal. At one point during my time with Little Otter the message option disappeared, but I emailed customer service and it was restored the same day.

Video Sessions

When it was time for a session we could log into our patient portal and connect to our Zoom link from there. Our initial care lead as well as our psychiatrist were easy to see and hear. 

Our provider was punctual for each session with no issues like background noise or grainy video. 

I was concerned that my young child would not be able to engage throughout our entire 75-minute assessment, but he was only needed for the first 20 minutes and then it was time for me and my spouse to speak with the psychiatrist on our own. While my son was talking with her she was friendly but serious, and he exhibited some shy behavior when he was expected to answer questions. Overall, I think she was able to get a good sense of his personality and demeanor. 

Little Otter advertises personalized mental healthcare and wellness, so the sessions are tailored to fit each family’s needs. My own child is at an age where he wouldn’t be expected to engage via Zoom for more than 15 to 20 minutes, so that’s all his psychiatrist asked for him during his appointment. I have personal experience talking to adolescent therapists, and, based on those experiences, I was impressed with our psychiatrist. I felt as if she immediately understood our situation and gave us plenty of time to talk about our concerns.

Medication Management/Psychiatry

During our initial psychiatric assessment, we spoke briefly about medication. We were clear that medication would be a last resort for us. Our doctor had clearly read all of our intake paperwork and had a good understanding of our son’s medical history. She brought up his heart condition, which would have prevented her from recommending certain medications. Because of this and our lack of interest in medication, we moved away from that conversation. It was, however, clear that if we were interested in medicating our child, then our psychiatrist would have taken this into consideration during her initial evaluation. 

What Happens If I Miss a Session at Little Otter?

There is a 24-hour cancellation policy. If you miss a session or cancel within 24 hours, you incur the charge of the session.

Switching Therapists at Little Otter

I completed a welcome session, a psychiatrist assessment, and a follow-up session. I did not have an opportunity or need to switch therapists.

However, if you do need to switch providers, you must contact your care lead and ask for this change. 

Switching providers is not recommended by Little Otter, so you might receive some pushback. Despite this, 20% of the users we surveyed switched providers once or two to three times, and 16% reported that they switched four or more times.

Pausing or Canceling Therapy at Little Otter

Our provider assured us that we could maintain our Little Otter account and access our patient portal even without sessions scheduled or purchasing a bundle. We told her that we would like to be in touch when the next school year begins and we have updates, at which time she said we can go ahead and schedule new appointments, if necessary.

We can also maintain our patient portal so that we have access to our records. 

Clients who would like to cancel their services and delete their profile need to contact help@littleotterhealth.com to have their account suspended.

Quality of Care and User Satisfaction

During our son’s psychiatrist assessment, we felt like we were in good hands with our doctor as she was able to speak with him and later listen to our specific concerns. We agreed that she would reach out to his teacher and I would complete some more forms before our follow-up appointment. 

Users seem to agree with our experience—75% of survey respondents rated Little Otter’s medication or psychiatry services as good, very good, or excellent. Seventy-nine percent of surveyed users reported positive ratings on their Little Otter therapist’s qualifications, and 58% would recommend Little Otter to a friend. 

The week between our assessment and our follow-up, I went onto the website to purchase a bundle and discovered that the pricing options had changed. It no longer offered bundles, but instead had an initial assessment and follow-up for $540, then a 12-session bundle for $2,040. The prices for a psychiatry session were not listed on the site. When I reached out for support, I was told that the $540 assessment plus follow-up bundle “does not apply to psychiatry sessions as those are provided by an M.D. and are much more involved than general therapy (provided by Ph.D., LMFT, etc.).” 

I felt aggravated by both the change in its pricing structure and the higher cost of psychiatry sessions. The FAQ page had offered a list of prices, but there is a separate page that went into more detail about the differences in pricing between therapy and psychiatry. I felt that Little Otter wasn’t being clear about its pricing, and I was also annoyed at myself for not doing thorough research. Of the users we surveyed, 72% rated Little Otter’s value for the money as either good, very good, or excellent—which is somewhat below the average of all the companies we surveyed.

While I liked our psychiatrist and thought we were on the right track with her, I was incredibly disappointed that Little Otter’s pricing didn’t reflect what is posted on its website, or the pricing that Rebecca Egger outlined when she responded to the company review questionnaire we sent her.

It’s worth noting that 62% of the users we surveyed think Little Otter’s services are better than others they’ve used in the past—which is much lower than the 86% average for all the companies we surveyed. Just 70% of users surveyed reported that all or most of their needs were met by Little Otter, again, below the average for all companies surveyed, which was 77%. 

In the questionnaire she answered for this review, co-founder Rebecca Egger claimed “when you join the Little Otter family, you receive 24/7 text access, same-day appointments with providers, a custom family mental health report with measurable insights, actionable feedback, and digital resources written by Little Otter’s experts.” 

I may not have been a user long enough to take advantage of all of these features, and I certainly appreciated the digital resources, but I did not have access to 24/7 texting or same-day appointments during my time with Little Otter. I didn’t feel particularly upset about this, but if I had continued weekly or monthly sessions with the company, I would have requested more comprehensive access. 

Privacy Policies at Little Otter

Unfortunately, the links I could find to Little Otter’s privacy policy linked back to my own patient portal, which I initially found concerning. 

That being said, the company outlines most of its policies on the terms page, and these bullets felt straightforward. It acknowledges that user’s information may be shared with third parties, but Little Otter is HIPAA compliant. 

Little Otter vs. Its Competitors

We surveyed users of Amwell and Kip Therapy—two direct competitors of Little Otter—to see how the services stacked up against each other.

Amwell, a telehealth company, offers therapy for adolescents ages 10 to 17 at the request of a parent or guardian. The website offers a comprehensive FAQ page and costs are lower than the national average. According to the website, “visits cost $109 (master’s level) or $129 (doctoral level), compared with the average national cost of $161, and usually just a co-pay or meeting a deductible if your employer or insurance company offers a telehealth benefit.” 

Eighty-eight percent of surveyed users rated their overall experience with Amwell as positive, with 78% of users reporting that they would recommend Amwell to a friend. Only 75% of Little Otter users gave a positive rating overal, and only 58% were likely or very likely to recommend Little Otter to a friend.

Kip Therapy had the lowest user reviews of each of Little Otter’s competitors, with only 54% of users reporting that they would recommend it to a friend. Kip Therapy is also the most direct competitor for Little Otter, as it offers child, adolescent, and family therapy services. According to its website, Kip provides “mental health care to people who have historically been excluded or misunderstood by traditional therapy..” Kip offers tiered pricing that ranges from $65 to $250 per session, while Little Otter’s listed prices and bundles are higher.  

Of users surveyed, 81% thought that Little Otter’s services were a little better to much better than others they’ve used in the past, and my own experience would support these positive reports. However, that’s still below Amwell’s 88% and Kip’s 83%. 

Final Verdict

My own experience with Little Otter was sullied by the inaccurate pricing information, but I am nevertheless confident that had my family continued with therapy through Little Otter, we would have felt like we were in good hands. 

The care team and the psychiatrist we met with were attentive and professional, and our psychiatrist in particular appeared to be very knowledgeable about every topic we discussed. She offered helpful insights and we felt like we were armed with useful information, even after our first appointment. 

Personally, I would exhaust in-network and in-person therapy and psychiatry options for my child and family before turning to telehealth. But for a mental health company that does not offer in-person services, I believe Little Otter does a good job of connecting families with mental health experts and offering helpful resources. I would recommend Little Otter to other families with young children.

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.