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An Introduction to Telebehavioral Health

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Presentation on theme: "An Introduction to Telebehavioral Health"— Presentation transcript:

1 An Introduction to Telebehavioral Health
Jodi Polaha, Ph.D., East Tennessee State University

2 Overview Presentation Style Dealing with Distance Example and Research
Setting It Up Mostly a talk geared to logistics. In looking over survey, saw lots of concerns/reservation about therapeutic relationship and quality of service (not as many about getting it paid for and ethics)

3 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Equipment Staff Scheduling

4 Setting It Up: Equipment
Provider Site: Teleconferencing Client site: Teleconferencing

5 Setting It Up: Equipment
Types: POTS, , internet, etc. Store-and-forward Robotic telepathology Home health devices Real-time video/two-way videoconferencing

6 Setting It Up: Equipment
Home Health

7 Setting It Up: Equipment
Videoconferencing Monitor-Based PC-Based, “Web Cams” Polycom, LIfeSize, Tandberg Logitech, Via-Video, ViGO

8 Setting It Up: Equipment
Transmission: Dedicated Line “T1” Faster/Clearer More stable More secure Internet “High-Speed”/Cable Cheaper Easier More flexible Look up notes from ATA about 128 vs. 376 etc. Discussion about how AFHCAN carts transmit +

9 Setting It Up: Equipment
Provider Site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Client site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Toys/Specialized equipment

10 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Equipment Staff Scheduling

11 Setting It Up: Staff Provider Site: IT person (on call) Coordinator
Client Site: IT person (on call) Coordinator

12 Setting It Up: Staff Provider Site Coordinator:
Maintains list of all sites, connection info Orients new sites Provides central point of contact for all parties Manages billing/insurance for provider Manages other paper work

13 Setting It Up: Staff Client Site Coordinator:
Coordinates room/equipment in advance Assists in insuring paperwork is administered Tests client equipment, demonstrates, troubleshoots *Insures professionalism, privacy at client site Provides point of contact for all parties during the visit

14 Setting It Up: Staff Checklist

15 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Equipment Staff Scheduling

16 Setting It Up: Scheduling
Patient/ Referral Source Clinician Site Coordinator Confirm Repeat Clinician Patient Site Coordinator Both “yes” Either “no”

17 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

18 Presentation Style: Camera Skills and Set Up
Sit > 8’ to improve “eye contact.” Frame head and tops of shoulders. Use PIP to insure your image. Practice with the remote. Be aware of “mute.” If possible, keep your materials in front of you.

19 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

20 Presentation Style: Meeting the Client
Checklist

21 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

22 Presentation Style: Theatrics
Wear blue, or at least, no stripes. Exaggerate nonverbal behavior. Label your “off screen” behavior. “Mute” your microphone when not talking.

23 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Building Rapport Camera Skills and Set Up Equipment Staff Cultural and Related Issues Meeting the Client Scheduling Theatrics

24 Dealing with the Distance: Building Rapport
Discuss concerns or skepticism at outset and throughout. “Shape” interaction with equipment by reinforcing verbalizations, use of remote, response to delay, etc. Consider having children or others who may be disruptive “skip” the first visit. Vocalize/ask about what you can’t see/hear. Reinforce patient responsiveness to atypical framework.

25 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Building Rapport Camera Skills and Set Up Equipment Staff Cultural and Related Issues Meeting the Client Scheduling Theatrics

26 Dealing with the Distance: Cultural and Related Issues
The State of New Mexico is importing its mental health services for the prison system from Indiana. What problems might be encountered from a therapeutic perspective? Can these be overcome? If so, how? If not, why?

27 Dealing with the Distance: Cultural and Related Issues
Engage site visits at intervals. Consider focusing on one geographic area. Know as much as possible about client’s town/geographic area. Acknowledge needs while working toward increased cultural competence. Take action when clients are not responding well.

28 Overview Setting It Up Presentation Style Dealing with Distance
Example and Research Building Rapport Camera Skills and Set Up Equipment Nebraska Program Staff Cultural and Related Issues Meeting the Client Other Research Scheduling Theatrics

29 MMI Behavioral Health Outreach Clinics 2006
Nebraska Program MMI Behavioral Health Outreach Clinics 2006 Gordon BHC Est at Gordon Medical Clinic Chadron BHC Est at Chadron Medical Clinic Valley BHC Est. 2003 Fremont BHC Est at Professional Partners Omaha-Metro Clinics Papillion BHC, 2000 Eagle Run BHC, 2001 Creighton BHC, 2003 Crawford BHC Est at Crawford Medical Clinic Columbus BHC Est at CCH Pediatric Kearney BHC Est at Kearney Clinic Pediatrics Plattsmouth BHC Est at UMA Plattsmouth Hastings BHC Est at Children and Adolescent Clinic, P.C Nebraska City BHC Est at Physicians Clinic Crete BHC Est at Physician’s Clinic Lincoln BHC Est. 2005

30 MMI Behavioral Health Outreach Program
Nebraska Program MMI Behavioral Health Outreach Program Mission 1. Provide Behavioral Health Services 2. Train and Retain Providers 3. Conduct research 4. Address public policy

31 Nebraska Program

32 The Pediatric Behavioral Telehealth Clinic
Nebraska Program Adjunct Service: The Pediatric Behavioral Telehealth Clinic Aims Provide temporary services as needed Provide “permanent” services as needed Provide value-added specialty services Give consumers choice Provide supervision for licensure

33 Nebraska Program Omaha Omaha

34 Nebraska Program: Services Provided
13 remote sites miles from Omaha 0-45 “consumer” miles (M=10)

35 Nebraska Program: Services Provided
Omaha Omaha

36 Nebraska Program: Services Provided
49 families in over 230 visits regular outpatient visits (n=0-18, M=6)

37 Nebraska Program: Services Provided
Age: M = 8.2 yrs Insurance: 45% Medicaid Referral: 75% primary care physicians 20% specialty clinics 5% other

38 Nebraska Program: Services Provided
Presenting Complaints: Disruptive behavior (ODD/ADHD)25 Behavior with MR Toileting Sleep Anxiety/Mood Hair Pulling Feeding Disorder 1

39 Nebraska Program: Outcomes
Teleconference Satisfaction Survey (Collected for 50% of the sample) Question Mean Score Standard Deviation Could see doctor clearly 5.43 .79 Had no trouble hearing doctor 5.29 .95 Able to speak freely and ask questions 5.76 .52 Doctor was able to ask me questions 5.80 .41 Doctor seemed to understand my problem 5.44 .91 I was comfortable with/understood what doctor told me 5.32 1.15 The camera made me embarrassed 1.72 1.27 Telemedicine makes care more accessible 5.86 .38 Telemedicine is as good as face-to-face encounter 5.00 .82 Overall, I am satisfied with telemedicine 5.71 .63 1=disagree; 6=agree

40 Nebraska Program: Outcomes
Teleconference Satisfaction Survey (Collected for 50% of the sample) Question Mean Score Standard Deviation Would prefer telemedicine visit rather than waiting for face-to-face 4.88 1.54 Would have traveled if not used telemedicine 4.76 1.59 Traveling would have cut into my work or school time 4.60 1.86 Traveling would have affected my wages 4.43 2.07 Traveling would have caused other inconveniences 5.00 1.83 Would prefer face-to-face visit rather than telemedicine 3.14 1.72

41 Nebraska Program: Discussion
Movement to more localized/regional model

42 Nebraska Program: Services Provided
Omaha Omaha

43 Nebraska Program: Discussion
Movement to more localized/regional model Increased rigor in outcome study Improvements to satisfaction survey

44 Nebraska Program: Overview
Setting It Up Presentation Style Dealing with Distance Example and Research Building Rapport Camera Skills and Set Up Equipment Nebraska Program Staff Cultural and Related Issues Meeting the Client Other Research Scheduling Theatrics

45 Nebraska Program: Other Research
Feasibility studies Satisfaction surveys Demonstration projects Controlled trials

46 September 2004

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