The Children’s Partnership Jenny Kattlove Senior Director, Programs Family Voices of California: 2016 Health Summit Sacramento, CA March 14, 2016 Meeting the Mental Health Care Needs of CSHCN: The Role of Telehealth

 One in five children will face a mental or behavioral health problem  Yet, many of these children, especially low-income children and those living in underserved areas, will not get the care that they need for a variety of reasons Shortage of pediatric mental health providers Lack of affordable transportation Lack of understanding of mental health issues and how to access care Stigma The Need to Identify Creative Ways to Meet Children’s Mental Health Care Needs

Unmet Needs for Mental Health Care Among CSHCN: Definition: Percentage of children ages 2-17 with special health care needs who received or did not receive needed mental health care in the past 12 months. Data Source: As cited on kidsdata.org, Child and Adolescent Health Measurement Initiative. National Survey of Children's Health. Data Resource Center for Child and Adolescent Health, (May 2013).

 Telehealth is the use of technology to provide, coordinate, and manage health care at a distance Live Video Conferencing (real-time) o Live, two-way interaction between a person or group of persons (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology Store-and-Forward (asynchronous) o Transmission of data, such as x-rays, photographs, video, and audio files for review and consultation at a later time Remote Monitoring o Personal health data collected from an individual in one location—via a smart phone or wearable device—and transmitted to a provider (sometimes via a data processing service) in a different location What is Telehealth?

 Telehealth can bring mental health care to children who may otherwise go without it  Mostly video conferencing  Some store-and-forward  Typically a rural clinic or other clinic connecting to a specialist  Can be clinic to clinic  Can be a school or regional center  Can be counseling, psychiatry, group therapy The Role of Telehealth in Meeting the Mental Health Care Needs of Children

 Schools are in a unique position to address children’s behavioral and mental health problems  Nationally, 91% of visits by students to school-based health centers are for mental health services, making it the top reason for such visits  70 to 80% of children who have mental health problems receive care at school  Yet, many schools don’t have the capacity to have mental health staff on site, even at a SBHC  Telehealth can complement school health services and bring mental health services to kids at school The Role of Schools in Delivering Mental Health Care to Children

 Children who would otherwise go without care can get it  Parents without affordable transportation can get care for their children  Parents don’t miss work and children don’t miss school  Relapse events can be lowered if telehealth enables a provider to deliver services quickly in a community setting versus appointments that take longer to arrange and get to at an off- site location  Families like it! “Kids like seeing themselves on TV”  Being able to get care at school makes children more comfortable (anonymity)  For children with many health issues, one less trip to the doctor is helpful and can reduce complications related to transportation  Children can be seen in their natural environment (e.g. behavioral health assessment in school)  Some studies have shown telehealth to result in better outcomes that face-to- face care Benefits of Telehealth

 Providers’ lack of knowledge about and/or how to use and bill for telehealth  Families’ lack of knowledge about the option to use telehealth  Lack of a mechanism for providers to bill for some services delivered via telehealth  Concerns by providers about the costs and maintenance of telehealth equipment  Concerns related to ensuring patient privacy  Lack of investment in starting and maintaining programs Barriers to Wider Adoption of Tele-mental Health

 Ensure State (CCS and Medi-Cal) pays for clinically appropriate telehea lth services  Expand locations eligible for telehealth payment to include patients’ home  Expand telehealth services that are reimbursable by Medi-Cal and the CCS program Services/specialties provided through store-and-forward technology should be expanded Reimbursement for remote patient monitoring (RPM) should be added Recommendations to Make Telehealth/Tele-mental Health More Available

 Ensure providers understand telehealth as an option and have the supp ort they need to use telehealth (e.g. technology, privacy, and billing supp ort)  Educate families about telehealth as an option  Equip families to educate policymakers and other decision-makers that telehealth should be widely available  Ensure broadband is available in every community  Work with schools and communities to bring telehealth to your school Recommendations to Make Telehealth/Tele-mental Health More Available

Contact Information Jenny Kattlove (310)