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

2. 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

3. 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)

4. 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)

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

7. 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

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

9. 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)

10. 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

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

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

13. Pulling it together
Linking Clinics with College through PolyCom Technology 2017

14. Pulling it together

15. 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

16. 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

17. 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

18. 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!

19. GO GAMECOCKS!!

20. 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, Parity or disparity: The state of mental health in America Alexandria, VA: Mental Health America.

21. 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 , NSDUH Series H-50). Retrieved from

22. 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 Accessed on March 21, 2017 from
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),

23. 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. A