1. Fostering Organizational Commitment for Broad Geographical Behavioral Health Services Using Tele-Health Technology Jean Scallon, MA, FACHE Joshua W. Paul, MA

2. The Problem of Access According to the Indiana Department of Health (2009/2012): 40% of Indiana counties have a shortage of psychiatric resources 50 counties do not have a practicing psychiatrist within their borders Particularly affects rural areas Clear relationship between quality of/access to health care and mental health Bottleneck effect on areas where there is service

3. Tele-Medicine as an Option Financially viable Minimal overhead Support multiple communities from one geographic location Increases access Expands reach and ability to interact with rural patients Improves ability to coordinate between multiple providers Improves quality Proven to be as beneficial as face-to-face interaction Some studies suggest that it may be more beneficial than face-to- face therapy for certain patients Reduced wait-time Easy-to-use technology

4. Trailblazer in Technology Award https://www.google.com/url?sa=t&rct=j&q=& esrc=s&source=video&cd=1&cad=rja&uact=8 &ved=0CD4QuAIwAA&url=http%3A%2F%2F www.youtube.com%2Fwatch%3Fv%3Dc_H6h pVCn3o&ei=25iEU6v7GsyTqga3noHAAw&usg =AFQjCNGC_NObnP8G8hDmUAJdTELpQAqj hA&sig2=8Dvbv63oDY-U38fT-pVz2Q

5. Challenges to Tele-health Technology Implementation Shift from local identity to regional Transitioning policy and personnel to support a larger & more diverse client base Significant and intentional effort Employee resistance to change New technology Tradition Group think Mistrust of management Poor communication General lack of buy- in

6. 1. Conduct a Market Assessment 2. Conduct a Organizational Assessment 3. Align Program Goals with Organization Goals 4. Identify Community Partners 5. Develop a Timeline 6. Identify Administrative/ Physician Champions 7. Train Providers and Staff 8. Start Small / Run a Pilot 9. Fully Integrate Tele-medicine Services Steps in the Process

7. Organizational Self-Assessment Measures do exist, see: Telehealth Readiness Assessment Tool Telehealth Capacity Assessment Tool (TCAT)

8. Developing Partnerships Partnerships, as compared to sole ventures, reduce risk Value adding to the partner organizations services Access to existing patients Partner organization options: Emergency Departments Physician Offices Detention Centers Schools Community Mental Health Centers Youth Shelters

9. Program Development / Resource Expansion Consider how the new program will affect current internal processes. If there will be a increase in patients seen, who will handle that increase? If you begin a 24 hour service, who will monitor its use, who will offer IT support if there is an issue? How does the off-site program affect medical records or any patient documentation?

10. Preparing for Identity Shift Methods for being culturally competent across broad geographic areas Encourage the recognition and understanding of personal worldviews Process-Oriented Models Outline the major service areas & cultural traditions/views/norms associated with each area Issues to Consider Ethnic and Linguistic diversity Population base inexperienced in cultural diversity Varying education levels Varying levels of comfort with the use of technology

11. The Language that we Use Tele-Health v. Tele-Assessment v. Tele-Medicine Make sure all staff, at all shifts, know the programs you are working on and developing. Make sure all staff understand the mission of the services. Make sure all staff know key personnel in each off-site program/location

12. Provider / Physician Buy-In Evaluate provider comfort with technology Current medical training does not specifically address how this technology will be used in their practice. Standardize process and ensure low barrier access to technology Speak to increased efficiency Provide simple equipment accommodations, such as: Dual Monitors (1 for tele-display) and one for chart Have administrative staff regularly check equipment and test before heavily scheduled time Consider hybrid patient loads – not all tele / not all in person

13. Physician / Provider Training Don’t assume people who are comfortable with using a computer will have the same level of comfort using tele-technology Allow for increased appointment time at first as the provider acclimates Ensure the administrative support on the patient is adequate—don’t assume it is the same structure as their in-person support. Offer support on how to describe the process to new patients.

14. Physician / Provider Productivity Offers the opportunity for increased productivity Entirely based on organization of schedule and administrative support Provider will still require time for charting – build this in

15. Patient Buy-In / Technology Acceptance Present to the patient the structure of their appointment BEFORE they arrive. Have materials ready that describes the process Brand the tele-equipment and room Have a printed bio or materials about the provider for the person to review Acknowledge that not all patients are appropriate for tele- and have a contingency

16. Marketing New Programs Utilize the existing network of partner to talk about services Develop materials that include the innovative nature of tele-services Focus on expanded service range and meeting the needs of underserved areas.