Tag Archives: child and adolescent psychiatry

Back-to-School Behavioral Health Check-Ins

This piece was written by Holli Stayton, nurse practitioner for Inpathy, InSight’s direct-to-consumer division. Originally published on American Journal of Managed Care

As summer draws to a close, parents naturally begin to consider back-to-school preparations such as well-checks with primary care providers and immunizations. As part of a holistic back-to-school wellness plan, it’s also important for parents to proactively monitor a child’s behavioral health and consider a mental health checkup in addition to a physical checkup.

The reality is that emotional wellness can take a downward turn as the start of school approaches. Reminders of school-related pressures are visible as early as midsummer as parents and children are exposed to an array of back-to-school advertising and school-related communication. These activities can cultivate anxieties and tensions well before the start of the new academic year, and it is not uncommon for demand of behavioral health services to soar near the end of the summer as parents identify concerning behaviors and begin back-to-school preparations.

Amid severe provider shortages, this increased need can create notable supply and demand challenges. Direct-to-consumer (D2C) telepsychiatry has emerged as an advantageous alternative that parents and children appreciate and value. A study in the Telemedicine Journal and e-Health even determined that telepsychiatry may be better than in-person care for younger age groups “because of the novelty of the interaction, direction of the technology, the psychological and physical distance, and the authenticity of the family interaction.”

The Behavioral Health Access Challenge for Children
Consider this all-too-common back-to-school scenario:

A child suffering from undiagnosed depression becomes agitated about the start of school in mid-July. As the weeks progress, parents begin noticing the child has become more withdrawn and is sleeping more. In August, the child becomes combative, lashing out at family members and responding to conflict in irrational ways.
The parents determine it is time to seek a psychiatric consult. Yet, when the attempt to schedule an appointment is made, they find out the child will have to wait 2 months for an appointment. During this time, symptoms continue to exacerbate, and the parents are left with few options.

Unprecedented demand exists for child and adolescent psychiatric services. The CDC has found nearly 1 in 7 children between the ages of 2 and 8 has a mental, behavioral, or developmental disorder. The statistics for preteens and teens aged 9 to 17 is higher—as many as 1 in 5.

Unfortunately, severe provider shortages, especially for child and adolescent specialty areas, are working against this heightened need. Currently, all states lack an adequate supply of child psychiatrists, and severe shortages exist in 43 states, according to the CDC. Some rural areas lack a single psychiatrist, and many behavioral health issues in children go undiagnosed or underserved.

For children who have a behavioral health diagnosis, it is important to schedule routine check-ins as part of a proactive approach to managing the disorder. Unfortunately, provider shortages make routine check-ins more difficult, and frustrated parents often let scheduling fall behind or give up. This often results in further disruptions in a child’s life and can require more costly interventions.

Fortunately, there is a better way.

The Telepsychiatry Advantage 
D2C telepsychiatry is quickly becoming a fundamental part of the solution to improve behavioral health access for children and adolescents, both at home and in schools. Powered by videoconferencing technology, these models are readily embraced by younger patients because they have grown up communicating via video and mobile devices.

Telepsychiatry not only helps normalize mental and behavioral health care with the use of technology, but it also helps breakdown barriers to establishing rapport with children because it gives them a greater sense of control. Interactions with behavioral health professionals can occur from the comfort of home or in a familiar, private setting where they feel safe.

In addition, the privacy afforded by these models helps alleviate concerns of running into peers in a waiting room or outside a facility and allows children and adolescents to learn to cope with whatever challenges are at hand in a comfortable setting.

Most notably, telepsychiatry opens doors to greater access while also providing a convenient means of scheduling appointments. In an academic setting, for example, staff can connect students with timely and proactive care directly on campus during times that align with their schedules. One alternative school in Pennsylvania, The Lincoln Center, has experienced success with its on-campus telepsychiatry program, which provides mental and behavioral health services to students who need such care on a regular, ongoing basis.

Because telepsychiatry providers are available for sessions outside of traditional office hours, parents can avoid missing work, and children do not have to miss school or sit in a waiting room—key advantages to ensuring added stressors are not placed on this age group while they are receiving help. Instead of waiting several months to see a behavioral health professional, children can typically schedule an appointment in less than 2 weeks—and at a convenient time.

In 1 instance, a student was at risk of getting expelled from school due to intensifying behavior issues in the classroom. The child’s mother faced significant struggles finding behavioral health support and medication management services. The telepsychiatry option was introduced and quickly embraced by both the parent and child, and now he is stabilized and thriving in the both his home and school environments.

Today, children and adolescents face unprecedented challenges and pressures. It’s important that parents proactively track not only a child’s physical well-being, but also his or her mental and emotional well-being. Back-to-school planning is an optimal time to consider a behavioral health check-in, and families and schools are increasingly turning to telepsychiatry as a viable and advantageous approach to better care.

St. Joseph’s Villa Uses Telehealth to Connect With Children in Crisis

Originally published on mHealth Intelligence 

Sometimes a telehealth program’s best feature is its ability to start a conversation.

At St. Joseph’s Villa in Richmond, Va., a simple virtual visit platform has turned an eight-bed crisis stabilization center into an indispensable resource for families of children aged 5-17 who are struggling with depression and anxiety. The 32-inch television and audio-visual telemedicine feed enable these kids to talk to a child psychiatrist based in New Jersey, and to connect with counselors at any time during their voluntary 14-day stay.

In the six years that the program has used telehealth, roughly 88 percent of those adolescent patients have gone back to their home or a less-restrictive facility, while 12 percent have gone to a hospital or similar institution. And about 16 percent have come back to the program.

Officials say the program isn’t about medicine, but about compassion.

“We’re not a medical model – we’re more of a social model,” says Craig Hedley, Director of Community Partnerships for the children’s non-profit. “In some ways that’s easier and more comfortable for them. You can see it in how they respond.”

Launched in 1834 by the Daughters of Charity, it’s the third oldest children’s program in the country, now offering a variety of programs for thousands of Virginia children and their families each year. The crisis shelter is one of those programs, offering a voluntary place to stay for those between the ages of 5 and 17 who are struggling with anxiety and depression, don’t qualify for hospitalization and can’t afford the thousands of dollars in co-pays for private services.

Hedley says the program offers troubled adolescents a place to feel safe, and to talk to counselors about their issues. But those counselors are hard to locate, expensive to hire and can’t always be found when they’re needed the most.

Seven years ago, armed with a 10-year state grant, St. Joseph’s installed a telemedicine station from InSight and connected with a child psychiatrist several states away. She handles most of the virtual visits during each patient’s two-week stay, while InSight provides 24/7 coverage when she isn’t available.

Hedley says he saw the difference in how the crisis center’s resident reacted to the technology.

“Kids prefer Skyping; they’re more comfortable with it than we are,” he says. “That makes them more (relaxed). And knowing someone is always available for them … really helps.”

The population served by St. Joseph’s Villa is growing at an alarming rate. The National Alliance on Mental Illness estimates that 20 percent of the nation’s teens are living with a mental health condition, and half of those diagnosed with a mental illness began to show symptoms by age 14. In addition, half of all teens diagnosed with a mental illness drop out of school, and three-quarters of teens now in juvenile justice programs are dealing with a mental health issue.

And suicide now ranks as the third leading cause of death among those age 14-24.

While the number of adolescents in distress is growing, the ranks of healthcare providers able to treat them are thinning. No state has an adequate supply of child psychologists, according to the American Academy of Child & Adolescent Psychiatry. And those who in the field are overworked, have waiting lists several months long and skew toward patients and programs that reimburse for their services.

That, Hedley says, leaves a large chunk of middle class America lacking the resources they need to treat an adolescent in need of mental health care.

“Who’s going to be able to afford thousands of dollars in co-pays?” he asks. “Who’s going to wait around six months to get an appointment? These kids are flat-line miserable and they need help. I like to tell the joke that I called the suicide hotline and was put on hold, but that’s kind of what it feels like.”

“We really are the first line of defense for these kids and their families,” he adds. “They’re stuck, and then there’s this a-ha moment … and things change.”

Hedley says St. Joseph’s focuses on the social aspects of treatment rather than the medical aspects. Everyone coming into the program does so voluntarily, and with support from the family. St. Joseph’s then works with the family, community resources school officials and others to create a support network for these patients when they’re discharged.

With a daily video link to specialists, he says, more of St. Joseph’s patients are prepared for what’s outside the program. They’ve had the opportunity to talk to someone who can bring them down off the cliff and into a more stable place, and they can talk in an environment that’s more comfortable for them, enabling them to open up more.

“This is cutting edge,” Hedley says of the telehealth platform.

Hedley expects the program, which received a telehealth innovation award in 2014 from the Mid-Atlantic Telehealth Resource Center, will continue well after the initial grant runs out. It will have proven its value, he says, in returning more children and adolescents with special needs to their families and their communities, rather than a hospital or institution.

He also expects to add telehealth services to several programs run by St. Joseph’s Villa.

“The ability to get these kids in front of people as quickly as we can is so important,” he says.

New Psychiatric Practice in New York Allows Individuals to Get Their Mental Wellness On(line)

Telebehavioral health allows individuals to attend sessions with behavioral and mental health providers online through secure videoconferencing. Inpathy is a division of InSight Telepsychiatry, the largest telebehavioral health organization in the nation.

Inpathy providers include adult and child and adolescent psychiatrists and psychiatric nurse practitioners that are available for psychiatric assessments, medication management and prescriptions when appropriate. Therapists and counselors are also available for talk therapy sessions through telehealth.

Many of the Inpathy telebehavioral health providers offer night and weekend appointments, which can be accessed through the internet from home using a smartphone, tablet or a computer with a webcamera. This makes managing behavioral health care more convenient by eliminating the need to travel to in-person appointments and sit in waiting rooms. Another benefit of telebehavioral health is that it is a more private way to access behavioral health services, which makes it a good option for individuals who are worried about a stigma on behavioral or mental health care.

Just like in an in-person office, the telebehavioral health providers who deliver services through Inpathy are fully supported by a clinical and administrative staff that handles their scheduling, billing, intake, general operations and clinical oversight.
Inpathy accepts insurance from several major insurance companies, including Aetna. For in-network telebehavioral health sessions, individuals are only charged their co-pay just like they would be for an in-person session. Inpathy providers are also available for out-of-network and cash-pay appointments.

“There is a huge shortage of psychiatrists across the nation,” says Geoffrey Boyce, executive director at InSight. “Telepsychiatry and telebehavioral health offer a unique solution for making psychiatry appointments easier to book and attend.”

Inpathy has telebehavioral health appointments available with many New York-licensed providers, including the following:

  • Doug Ikelheimer, MD- an extremely experienced telepsychiatrist with expertise in the psychopharmacologic management of mood disorders, anxiety disorders, chronic mental illness and addictions
  • Catherine Newton, LCSW – a licesnsed clinical social worker who specializes in working with individuals who have experienced trauma and is trained in Eye Movement Desensitiazation and Reprocessing (EMDR)
  • Ragy Girgis, MD – a board certified psychiatrist with an interest in the psychopharmalcologic management of schizophrenia, mood disorders, anxiety disorders and eating disorders in adults
  • Hinna Shah, MD – a board certified adult and child and adolescent psychiatrist with experience working with individuals who have depression, bipolar disorder, anxiety disorders, autism spectrum disorder and ADHD
  • Liz Espinoza, LCSW – a Spanish-speaking licensed clinical social worker who is interested in helping individuals achieve life goals and specializes in anger management, relationship, communication and life transition issues

Telehealth is a rapidly growing industry and more and more insurance companies and providers are offering this form of care. Numerous studies have shown telebehavioral health to be as effective as in-person behavioral health services in most situations.

To get started as an individual using telebehavioral health care, individuals can visit http://www.inpathy.com to search the Inpathy provider directory, sign up, select an appropriate provider and schedule a session. Inpathy has a 24-hour technical support line and care navigation team that can be reached at 1.800.442.8938.

InSight is also in the process of developing referral relationships with a number of New York organizations that could benefit from additional behavioral health services for their clients. To learn more about this or connect individuals you know to care, visit http://www.inpathy.com.

Cathy Newton

St. Joseph’s Villa and InSight Telepsychiatry Bring Psychiatric Care to Children in Crisis Stabilization Unit

April 19, 2016 | St. Joseph’s Villa of Richmond, Va. works with InSight Telepsychiatry to bring telepsychiatry services to their Crisis Stabilization Unit, an innovative program in a unique setting that diverts children in mental health crisis from unnecessary hospitalization.

RICHMOND, Va. — St. Joseph’s Villa is collaborating with InSight Telepsychiatry to bring telepsychiatry to children receiving mental health services at their facility. St. Joseph’s Villa (SJV) provides children and their families with a variety of social services. One of SJV’s many innovative and effective programs is their Crisis Stabilization Unit (CSU), where children experiencing mental health crises can go to receive treatment in an environment that feels like home — all with the goal of preventing costly, unnecessary hospitalization. Since opening in 2012, the CSU has served nearly 500 children and has successfully diverted nearly 90 percent of them from hospitalization. InSight has helped the CSU work toward this goal for nearly two years.

Located in a repurposed cottage with spacious bedrooms and recreation areas, SJV’s CSU’s six-bed facility acts as a hybrid between a residential home and a hospital. This hybrid model allows SJV to offer clinical services, including telepsychiatry, while giving children in crisis a less restrictive environment than that of traditional residential treatment centers.

A first-of-its-kind facility in central Virginia, the CSU was a runner up in the Innovative Practices Award presented by the Council on Accreditation to spotlight organizations that bring lasting change to the lives of vulnerable individuals through unique, forward-thinking initiatives.

Telepsychiatry allows children in the CSU to see psychiatry providers through videoconferencing. With the option to utilize remote providers, telepsychiatry and other telemedicine services represent unprecedented access to specialists who are typically difficult to staff in rural and underserved areas. When the CSU opened in partnership with the Richmond Behavioral Health Authority (RBHA) Region IV, SJV found that it was challenging to locate a qualified local child psychiatrist. In terms of mental health providers, several of the counties SJV’s CSU serves are Designated Health Professional Shortage Areas, according to the U.S. Health Resources and Services Administration.1 Ultimately, SJV turned to telepsychiatry as the solution for bringing psychiatric care to their facility.

Telepsychiatry isn’t just a means of bringing access to care. The telepsychiatry medium is able to help these children express themselves better, says Craig Hedley, SJV’s Director of Community Partnerships. “Kids are used to Skyping, but they can be intimidated by adults. Children can relate to them better through a TV screen, which provides them a layer of safety and protection,” he says.

The CSU collaborates with an InSight telepsychiatrist for about 15 hours a week of regularly scheduled services. The telepsychiatrist, Dr. Ashika Kapoor, helps onsite providers assess children’s symptoms and manage their medications.

“There are unique challenges to working at a crisis stabilization unit, but I really enjoy being a part of a team approach,” Dr. Kapoor says. “The staff at St. Joseph’s Villa are a wonderful group of individuals who do amazing work together as a team.”

According to Hedley, Dr. Kapoor is a flexible asset to this team-oriented approach and goes out of her way to help the team help the children for which they care.

“Dr. Kapoor is extremely invested in our program,” Hedley says. “Her responsiveness is incredible.”

The relationship between the InSight telepsychiatry provider and onsite staff is vital to the success of SJV’s CSU program.

“InSight believes in the importance of partnering with innovative, like-minded organizations and working hard to find the right fit between our psychiatrists and our partners,” says Geoffrey Boyce, Executive Director of InSight. “Integrating Dr. Kapoor onto the St. Joseph’s Villa CSU team has been a wonderful success.”

InSight Telepsychiatry is the leading national telepsychiatry service provider with a mission to increase access to appropriate behavioral health care. Telepsychiatry has been proven an effective and cost-conscious way to bring psychiatric care to children.2 Forty percent of InSight’s telepsychiatry providers are child and adolescent psychiatrists.

“The partnership between InSight and St. Joseph’s Villa shows how we can combine modern technology and personal touch to offer a meaningful and potentially life changing service to patients and families in their time of need,” says Dr. Kapoor. “Together we are able to help children and families through a difficult time in their lives and provide them with opportunities to succeed.”

 

[1] http://datawarehouse.hrsa.gov/tools/analyzers/HpsaFind.aspx

[2] Myers, K. M., Valentine, J. M., & Melzer, S. M. (2008). Child and Adolescent Telepsychiatry: Utilization and Satisfaction. Telemedicine and EHealth, 14(2), 131-137. doi: 10.1089/tmj.2007.0035

Types of Behavioral Health Providers

Advanced Practice Registered Nurses (APRN) earn master’s or doctoral degrees in psychiatric-mental health nursing. APRNs apply the nursing process to assess, diagnose, and treat individuals or families with psychiatric disorders and identify risk factors for such disorders. They also contribute to policy development, quality improvement, practice evaluation, and healthcare reform. APRNs practice as Clinical Nurse Specialists (CNS) or Nurse Practitioners (NP).

Licensed Professional Counselors (LPCs) primarily specialize in psychotherapy. The exact title for these professionals varies by state. In addition to secondary education (either a master’s or doctorate in counseling), LPCs must obtain supervised clinical experience and pass state-specific licensing exams. LPCs may specialize in certain areas like marriage issues or substance abuse. LPCs do not prescribe medications and typically do not offer formal diagnoses.

Psychiatric Mental Health Nurses (PMHN) have either a bachelor’s or master’s degree in nursing and offer services that can include assessment and treatment of psychiatric illness, medication management, and psychotherapy. PHNSs have special training in the care of people with psychiatric illness or distress including the administration of psychiatric medication and skills for dealing with challenging behavior associated with behavioral health disorders.

Psychiatric Mental Health Nurse Practitioners (PMHNP) have a master’s degree in nursing practice and can offer assessment, diagnosis, prescriptions, and psychotherapy. PMHNPs are licensed to provide emergency psychiatric services and manage all stages of consumer care. They may also serve as consultants or educators for families and health care staff. PMHNPs can diagnose and treat patients in 27 states, and can diagnose, treat, and prescribe medication in 19. In the remaining states, PMHNPs collaborate with physicians to determine the scope of their practice, and physician sign off on diagnoses and treatment prescribed by the psychiatric nurse practitioner.

Psychiatrists (M.D. or D.O) are medical doctors with training in behavioral health. They can diagnose behavioral health conditions and prescribe treatment, both medication and psychotherapy. Psychiatrists can also provide psychotherapy. Psychiatrists gain licensure to practice psychiatry in individual states. Many psychiatrists undergo an additional year of fellowship training to become specialized in a specific field. The specialties of psychiatry are:

  • Child and Adolescent Psychiatry- Child and adolescent psychiatry emphasizes the developmental differences between children and teens of different ages.
  • Geriatric Psychiatry- Geriatric psychiatry focuses on the biological and psychological aspects of normal aging, as well as the biological and psychosocial aspects of psychiatric disturbances common with old age.
  • Addiction Psychiatry- Addiction psychiatry is concerned with the diagnosis and treatment of addiction, both as a primary diagnosis and as a secondary issue within a psychiatric profile.
  • Forensic Psychiatry- Forensic psychiatry covers the meeting between law and psychiatry. Forensic psychiatrists primarily provide services, such as providing expert witness testimony or making the determination of a person’s ability to stand trial.

Psychologists (Ph.D., PsyD.,Ed.D.) are trained in the science of psychology. Psychologists are either in clinical, educational, counseling, or research settings. Those in clinical settings diagnose, facilitate psychological testing, and offer psychotherapy. Psychologists gain licensure to practice psychology in individual states.

Social Workers (LCSW) vary significantly in credentials and licensing and can provide a range of services based on those credentials. Typically, social work is broken into two categories: direct service and clinical. Clinical social workers are licensed to practice psychotherapy, recommend treatment from other specialists, and typically work one-on-one with consumers. Direct service social workers provide services on the macro level, usually in administrative positions within programs, institutions, and committees that serve to help people.

  • Social Workers in Administration, Policy, and Research
  • Child, Family, and School Social Workers
  • Gerontological Social Workers
  • Medical and Health Social Workers
  • Mental Health and Substance Abuse Social Workers
  • Military and Veterans Social Work
  • Palliative and Hospice Social Work
  • Psychiatric Social Work
Interested in Receiving Care?
Online Therapy and Psychiatry

You can use telehealth to connect with licensed professional therapists, counselors and psychiatry providers through convenient, online video calls on Inpathy. Inpathy’s providers see individuals and families anytime and anywhere through safe, confidential and HIPAA-compliant online video calls made in real-time from a computer, tablet or smart phone equipped with a webcam. No special equipment, software or app downloads are needed.

Want to know more about the benefits of online therapy and psychiatry? Read the Inpathy benefits page.