Telemental Health Connect (TeleCon): Between OK and ER Tena Hunt McKinney, PhD, APRN and Drs. Betsy Blake, Teri Browne, and Kathrene Brendell

TeleCon Team Betsy Blake, PharmD, BCPS Teri Browne, PhD, MSW, NSW-C Kathrene Brendell, DNP, APRN, PMHNP-BC Tena Hunt McKinney, PhD, APRN, PMHNP-BC

Telemental Health Connect (TeleCon) Problem: There are too few behavioral health providers to meet the outpatient care needs in rural SC. OK ER SC Institute of Medicine and Public Health’s outpatient model for chronic care management is to support patients in recovery from mental disorders in the community. This includes ongoing outpatient therapy, medication management, stable housing and other social determinants of health. (transportation, access to pharmaceuticals, links to other services.) Integrated clinical care and access to care coordination GAP IN SERVICE FOR NON-ACUTE (Pack & Fradua, 2015)

The Problem? Mental Health and Substance Use Disorders are often recurrent or chronic 41/46 counties designated as underserved for mental health in SC Scarce supply of providers 99 advanced practice nurses/33 are PMHNPs 466 psychiatrists According to the imph.org According to the WHO, collectively Behavioral Health Disorders are the leading cause of disability in the U.S. People with serious mental illness die up to 23 years soon than other Americans..giving them a life expectancy on par with people in Bangladesh. Szabo (2014) (IMPH.org; SAMHSA, 2014; Sazbo, 2014; USDHHS, 2013)

Requests for Mental Health Providers Private Psychiatrist Offices Counselors SCDMH- Mental Health Centers/Clinics Carolinas Health System VA Hospital System Child/Adolescent Service Providers

Costs of Acute Mental Health Care In 2015 – 17,281 hospital discharges - $455,548,774 9,937 admitted through ED $292,105,771 70,588 ED visits $240,644,215 (SC Revenue and Fiscal Affairs, 2015) Discharges and visits for mental health disorders: psychosis, depression, anxiety, etc. Average charge is $22,000 for inpatient care and avg LOS 6.4 days Average charge for ED is $3,035

THINKING BIGGER & THINKING BETTER.. Expanding mental health collaboration & comprehensive service penetration in SC THINKING BIGGER & THINKING BETTER..

TeleCon Purpose To prepare health professionals to work in collaborative practice. To survey and address social determinants of health in rural areas of SC. To build flexible, safe, patient-centered and community-oriented care systems. So we wrote grant proposal for the Duke Endowment To both train interprofessional, health professions student teams And To provide a service for PCPs and patients in rural or underserved areas. (Thistlewaite, et al., 2014)

Interprofessional Education at USC Nursing Public Health Social Work Medicine Pharmacy IPE Curriculum, IPE Research, IPE Service Projects At USC, we already had IPE resources and Mental Health and Telehealth expertise, USC Committee started 2011 Supported by Provost and President All health sciences (including social work and public health) involved from the beginning Curriculum, service, research

Pulling it together Opened Program 2015 Expanded Sim Space Up fitted Rural Clinic

Estimated 600 pt/yr needing services. Free Medical Clinic MDs, NPs; Estimated 600 pt/yr needing services. Additional Rural Clinics: TBA

Pulling it together Linking Clinics with College through PolyCom Technology 2017

Pulling it together

Pulling it together Menu of Services Psychiatric interviews Medication review and assessment Holistic, lifestyle assessments and health education Motivational Interviewing and substance abuse screening, brief intervention and referral for treatment (SBIRT) Stress management training Brief CBT or supportive counselling

What is the process? Provider identifies appropriate patients Patient consent obtained Clinic staff schedules visits through CON Coordinator Psych NP faculty reviews the EHR Psych NP provides oral pt report to interprofessional student team

What is the process? Precepted, TeleTeam & patient encounter Report assessments and recommendations to PCP/Document Open communication with clinic staff Schedule f/up for services or PCP support prn

Did it work? Evaluation Pt: Acceptability, Satisfaction, MH Hosp. TeleCon Students: Attitudes & Competencies PCP: Attitudes & Satisfaction Preceptor: Attitudes & Satisfact Next Steps: Evaluate Pilot and Scale what works!

GO GAMECOCKS!!

References Hilty, D.M., Ferrer, D.C., Parish, M.B., Johnston, B., Callahan, E.J., & Yellowlees, P.M. (2013). The Effectiveness of Telemental Health: A 2013 Review Mental Health America, 2014. Parity or disparity: The state of mental health in America 2015. Alexandria, VA: Mental Health America.

Pack, M.H., & Fradua, K. (2015). Hope for tomorrow: The collective approach for transforming South Carolina’s behavioral health systems. SC Institute of Medicine and Public Health. SAMHSA Center for Behavioral Statistics and Quality (2014). Behavioral health trends in the U.S.: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/data/

SC Revenue and Fiscal Affairs: Health and Demographics (2015) SC Revenue and Fiscal Affairs: Health and Demographics (2015). Analysis of inpatient discharges by selected characteristics, federal fiscal year 2015. Accessed on March 21, 2017 from http://rfa.sc.gov/_hd/utilization/ipquery-result.php. Szabo, L. (2014). Cost of not caring: Nowhere to go: A manmade disaster. USA Today, May 12, 2014. Thislethwaite, J. E., Forman, D., Matthews, L.R., Rogers, G.D., Steketee, C., & Yassine, T. (2014). Competencies and frameworks in interprofessional education: A comparative analysis. Academic Medicine, 89 (6), 869-875.

U.S. Department of Health and Human Services: Division of Public Health Informatics (8/19/2013). South Carolina Health Professions Shortage Area by Type. World Health Organization (2004). Changing history. Annex Table 3: Burden of Disease in DALYs by case, sex, and mortality stratum in WHO regions. Geneva: WHO. A126-0127