1. Reaching Women, Restoring Health: Using Urban Telemedicine to Connect with Women with Substance Use Canadian Public Health Association Conference May 27 2014 Rosanra Yoon, NP, PhD Candidate Chelsea Kirkby, MPH

2. Women recovering from substance use often experience barriers to accessing timely and appropriate health care. Telemedicine enables individuals to access and connect with health care providers utilizing video conferencing technology. Background

3. Women with mental health, substance use and/or concurrent mental health problems engaged in the services of the Jean Tweed Centre in Toronto. Consultations and educational sessions for inter professional frontline staff, and community partners. Target Population

4. Key objectives of the development and implementation of the telemedicine Nurse Practitioner services at the Jean Tweed Centre include: Increased access to woman-centered, trauma-informed health care for women living with mental health, substance use and/or concurrent mental health problems. Enhanced inter-professional collaborative care. Provision of integrated addictions, mental health and primary health care for women with multiple health needs. Objectives

5. Activities The Jean Tweed Centre  OTN Telemedicine  Main clinical site – NP is on site majority of the time Education/Consultation  NP offers health education sessions on relevant topics for women and/or JTC staff and other health and social service providers  NP is available for consultation with Jean Tweed staff and partners/external agencies Addiction Supportive Housing (Two partnerships with housing locations across Toronto)  OTN Telemedicine access  Consultation with NP via OTN  Scheduled clinic days with NP on site Hospital Partnership  Hospital’s OTN Equipment  NP consults with health care providers at hospital via OTN  Women at Mental Health and Withdrawal Management Services consult with NP via OTN.

6. Successes 175 unique clients seen by NP (in person or via OTN) 14 clients have been seen by NP over OTN 12 ER visits have been diverted 98% of clients were satisfied or very satisfied with the services they received Most women reported having their medical needs met quickly and effectively while continuing to participate in addiction and mental health programming. Challenges Staff uptake (e.g. prohibitive cost and time commitment for single-user system, some staff uncomfortable with the technology, OTN can be time consuming for staff who are working in fast-paced environment) Acceptability of telemedicine by women, especially women with trauma Outcomes

7. Program Development and Evaluation Important to develop program from a trauma-informed approach and build on feedback/acceptance of the process and the use of technology. In this case, building rapport between NP and women before introducing telemedicine seems to be important. Program evaluation should take into consideration what metrics are best to measure the success and impact of the project. In this case, experience and engagement with healthcare provider from women would offer valuable information for quality assurance and acceptability by the women. Implications

8. Policy In this case, there is great opportunity for exploring appropriate, trauma- informed, acceptable, and cost-effective use of telemedicine technology that is tailored to specific populations, is responsive to context and setting, and is supported within the larger health system. Policies that support evolving projects such as this with the goal of strengthening inter-professional collaboration and improving the health and well-being of those with complex health issues are necessary. Implications