1. Telepsychiatry for Patients with Co-morbid Psychiatric and Substance Use Disorders. A UCLA Integrated Substance Abuse Programs (ISAP) and Los Angeles County Pilot Project ADP Training Conference Integration in the Field: County Initiatives August 22, 2012 Sacramento, CA Loretta L. Denering, M.S. Project Director

2. Telemedicine/Telepsychiatry Overview Telemedicine: “the practice of health care delivery, diagnosis, consultation, treatment and transfer of medical data and interactive tools using audio, video and/or data communication with a patient at a location remote from the provider.” Has been in use for over 20 years. Telepsychiatry/Telemental Health is a potentially important application of telemedicine (Rost et al. 2002). Telepsychiatry has been practiced within the University of California (UC) system since the late 1990’s and since 1996 UC Davis has provided over 5000 clinical consultations and has been awarded 10+ grants in this area.

3. Telepsychiatry Telepsychiatry allows the psychiatrist to meet with and monitor patients via a secured web-based application. Telepsychiatry is accomplished though the use of special software and/or a freestanding mobile cart that includes a computer connect to the Internet, a camera and a microphone.

4. Telepsychiatry Studies thus far have demonstrated comparable levels of efficacy compared to routine live clinical visits (Hilty et al. 2004; Hyler et al. 2005; Norman 2006; Richardson et al. 2009).

5. Targeting Unmet Needs Research suggests that 33%-50% of patients in substance use disorder (SUD) rehabilitation programs often have co-morbid psychiatric problems (Drake et al. 2007). Very few rehabilitation programs (and even fewer rural programs) have on-site psychiatrists (Hilty, 2008). This project started in April 2011 is an innovative partnership between UCLA ISAP, the Los Angeles County Department of Public Health and the Los Angeles County Department of Health Services. Telepsychiatry services are provided for patients admitted to the County operated Antelope Valley Rehabilitation Center (AVRC) in Acton, CA.

6. Background: UCLA/AVRC Telepsychiatry program The AVRC is located in the high desert of LA County where access to psychiatric services is limited due to the remoteness of the facility. Currently, UCLA provides psychiatric care to patients one day/week (4 hours). Patients with severe and persistent mental illness (SPMI) and are eligible for services via the LA County Department of Mental Health (DMH) are transported to a DMH-operated clinic in Palmdale. Patients in this project all have a DSM-IV-R SUD plus significant psychiatric co-morbidity, but do not qualify as (SPMI).

7. UCLA/AVRC Telepsychiatry Protocol 1.Patients are identified by the AVRC psychologist or LCSW as appropriate to receive telepsychiatry services. 2.Patients complete telemedicine information sheet, telemedicine consent form, and multi-consortium consent form. AVRC staff faxes via a secure line and mails hard copies to UCLA Neuropsychiatric Hospital. 3.Patient registration is processed and UCLA medical record numbers are issued.

8. UCLA/AVRC Telepsychiatry Protocol 4.Registration information is forwarded via secure line to ISAP psychiatrist. 5.AVRC mails copies of patients’ clinical information directly to ISAP psychiatrist. 6.ISAP psychiatrist conducts the session and completes dictations which are stored with the patients’ UCLA patient record. - Copies are sent via a secure line to the medical personnel at the Acton facility for placement in the patient’s AVRC file. 7.Prescriptions are written by the UCLA psychiatrist and filled at a local Acton pharmacy.

9. Clinical Activities To Date As of August 1, 2012: 120 unique patients have been registered and 106 have had at least 1 session. 71 diagnosed with Major Depressive Disorder (MDD) 5 diagnosed with Bipolar Mood Disorder 38 diagnosed with Anxiety Disorders (Generalized Anxiety Disorder and Panic Disorder) 6 diagnosed with Psychotic Disorders (Drug-induced psychosis vs. Schizophrenia) Using a low-cost medication formulary, psychotropic medications are prescribed.

10. Outcomes Thus Far This project has also been well-received by UCLA and AVRC staff

11. Outcomes Thus Far So far, this project has resulted in a number of positive outcomes including: a reduced barrier to access for those in remote areas and an increase in efficiency for the AVRC and UCLA systems.

12. Next Steps We hope that improved mental health outcomes will be noted as a result of the continuous care. Other potential benefits include opportunities for enhanced cultural competency (i.e. increased interaction with traditionally under served ethnic groups). A report will be written in the next year to discuss SUD and mental health outcomes and results of the satisfaction survey.

13. Thank you! Any Questions? Loretta L. Denering, M.S. Project Director ldenering@mednet.ucla.edu