1. TELEPSYCHIATRY MARYLAND RURAL DEVELOPMENT GRANT Delta States September 2009 Brian Grady University of Maryland Holly Ireland Mid-Shore Mental Health Jean Honey Project Coordinator

2. BACKGROUND  One Year Grant with 2 one-year potential continuations  MSMHS Lead Agency Partners Maryland Department of Health and Mental Hygiene (DHMH) University of Maryland School of Medicine Department of Psychiatry Garrett County Core Service Agency St Mary’s County Department of Human Services

3. Mental Health Professional Shortage Area Designations By Rural/ Non Rural Classification at 11/2008 Single (Entire) County Comprehensive Health Center Facility

5. Counties Seven Rural Counties: St. Mary’s, Garrett, Caroline, Dorchester, Kent, Queen Anne’s and Talbot Mental Health Care Professional Shortage Area

6. Sites  Caroline: Caroline County Mental Health Clinic  Dorchester: Wellness Center Mace’s Lane Middle School  Garrett: Garrett County Health Department  Kent: A.F. Whitsitt Center  St. Mary’s: Pathways, Inc  Talbot: Maple Shade Youth and Family Services  Priority Populations: Child/ Adolescent, Geriatric, Co-Occurring Substance Abuse, Deaf/ Hard of Hearing

7. Operational Framework  Time Line – Announced May 2008  October 27 – November 5 th : Installation of Equipment  Procedures/Schedules/Outreach  Targets – Through April 09: 117 clients/333 encounters – Through 3 year project: 585 clients/ 1,665 encounters – 85% Satisfaction – 95% Completion

8. University TMH Philosophy  Quality Mental Healthcare  Improve Access  Cost Effectiveness  Utilization of Limited Resources

9. BENEFITS Consumers: Overall Increases Choice, independence and quality of life  Reduces Appointment Wait Times  Early intervention and treatment  Access to Specialist Providers  Continuity Between Appointments  Reduced ER visits and Inpatient Length Providers: Increases clinical capacity  Connected to Academic Centers, Meetings, Training, Group Therapy

10. Textbook Implementation Strategy*  Alliance  Assessment  Approach  Access  Accountability  Apprehension  Anticipation *Grady BJ. Chapter 41: TelePsychiatry, Textbook Of Consultation-Liaison Psychiatry, Edited by Wise, MG, Rundell, JR, APP, 2002.

11. Alliance  Consultant/Consultee “Ivory Tower” Communication  Consultee/Patient Attitude toward MH  Consultant/Patient  Administrative and Support Staff

12. Assessment  Needs/Resources of Originating Site Equipment, Capacity, Staff, Budget  Capabilities/Resources of Distant Site Equipment, Capacity, Staff, Budget  Personal Investment Distant Site Originating Site

13. Approach  Clinician Driven  Consultee Orientation  Appropriate Patient Selection/ Evaluation/Treatment

14. Access  Patient Specialty Care  Originating Site Located within the clinic  Distant Site Located within the clinic

15. Accountability  Standard Operating Procedure/Protocols  Records  Cost

16. Apprehension  Risk/Benefit Ratio  Cost/Benefit Ratio  Patient Information –Security –Privacy –Confidentiality

17. The Seventh "A"  Hub –Patient Safety –Equipment Failure –Staffing Problems  Satellite –Patient Safety –Equipment Failure –Staffing Problems Anticipate

18. 18 Success Depends On  Interest  Alliance  Simplicity  Appropriate Use of Resources

19. How Are We Doong?  Alliance –Consultant/Consultee –Consultee/Patient –Consultant/Patient –Administrative and Support Staff  Assessment –Originating Site –Distant Site –Personal Investment  Approach –Clinician Driven –Consultee Orientation –Appropriate Patient Selection/ Evaluation/Treatment

20. How Are We Doing?  Access –Patient  Accountability –SOP/Protocols –Records –Cost  Apprehension –Risk/Benefit Ratio –Cost/Benefit Ratio –Patient Information  Anticipation

21. Telepsychiatry Development Grant Program Choices:  Factors Uncontrollable –Grant Rural Eligibility Requirements –State Mental Health Services Organization  Factors Limited Control –Patient eligibility/participation –Provider participation –Site participation –Steering Committee Participation –Sustainability/Economics –Clinical Practice Model 21

22. Telepsychiatry Development Grant Program Choices:  Factors Controllable –Lead Agency –Staffing –Project Management –Grant Reporting –Tech Support –Data Analysis 22

23. THANK YOU QUESTIONS?

24. 34 States Nationwide Reimburse for Telemedicine Medicaid Reimburses Telemedicine No Statewide Reimbursement