Tag Archives: psychiatrist

Telehealth: Transforming Child Mental Health Care

By: Jeanine Miles, LPC

Original article published on NAMI

Unprecedented need exists for child and adolescent mental health services in today’s communities, however, parents have limited options at their disposal. Shortages of child psychologists and psychiatrists are leaving our most vulnerable populations without care. Currently, all U.S. states are facing high or severe shortages, with many communities lacking even one qualified child and adolescent psychiatrist.

We need an effective solution, and it might be telebehavioral health. This convenient, accessible model of care has been gaining traction: Studies consistently reveal high satisfaction rates for children, adolescents and parents, often reaching above 90%. In fact, a 2013 studydetermined that telebehavioral health might be better than in-person care for children and adolescents because this age group often expresses an unwillingness or reluctance to participate in traditional therapy sessions.

Telebehavioral health might be a natural solution for improving access to care, but that’s just one benefit. As a counselor who offers telesessions, I’ve seen many more. Consider the following:

Comfortable Surroundings

Clinical office settings often intimidate children and adolescents. I find that younger populations are more willing to open up when they are in their own environment surrounded by familiar possessions or in reach of pets who may offer comfort. With telebehavioral health, I also get clues and information from a home environment I never see in an office setting.

For example, one child was well-behaved during our traditional office appointments. Yet her mother described a very different child with erratic behaviors while at home. Through our telebehavioral health sessions, I could see family interactions that confirmed the mother’s assessment. I was then able to teach the young girl and her family healthy coping techniques right there “at home.”

Familiar Modes Of Communication

Younger generations have grown up with technology. In fact, a 2015 study shows 67% of teens own a smartphone and spend more than four hours daily engaged with it. Videoconferencing, therefore, is a natural fit for today’s youth. Many teens prefer telesessions compared to traditional office sessions because it’s familiar and helps build trust. Simply put: Today’s youth are more comfortable communicating through a screen.

Easier Scheduling

One of the greatest barriers to engaging younger populations in mental health treatment is stigma. Many adolescents fear their peers will find out they go to therapy and ask questions. Professional shortages and scheduling challenges often causes students to miss school to attend therapy sessions. When a student leaves school early or checks in late, their peers may ask questions or make them feel uncomfortable.

With telebehavioral health, scheduling becomes much easier, as sessions can take place outside of traditional office hours. Patients do not have to miss school, nor do they run the risk of running into someone they know in a waiting room.

When choosing a telebehavioral health care organization or provider for your child, it’s important to do research before pursuing treatment. Things to consider are whether or not they are HIPAA-compliant, if they offer technical or care navigation support, whether they have providers licensed in your state, and if you can pay with your insurance plan. A good place to start is a reference guide, such as the one created by Open Minds that lists reputable telebehavioral health organizations.

Telebehavioral health care is changing the way communities and families approach mental health services. At a time when the need for mental health care is soaring, this option holds great promise for addressing gaps in care and providing parents with a critical resource for addressing their child’s health and well-being.

 

Jeanine Miles, LPC, Cognitive Behavioral Therapist with Inpathy and the Director of Business Development and Training at the Center for Family Guidance. Jeanine is a New Jersey Licensed Professional Counselor and has over 20 years of administrative and management experience in healthcare and behavioral healthcare. She is responsible for the development and implementation of new programs including overseeing all start-up projects, social skills training and school based programs. Jeanine has provided therapy and other telebehavioral health services through Inpathy since the program was launched and has long been an advocate for telebehavioral health.

 

 

Delaware Takes Its ACT to the Next Level

A Delaware ACT team conducts a weekly briefing with its telepsychiatrist.

Delaware is known as the “First State” since it was the first colony to ratify the United States Constitution, but that motto can also apply to another bold step undertaken in the state more recently. A few years back, Delaware became the first state to merge telepsychiatry with assertive community treatment (ACT).

Two teams managed by the nonprofit Resources for Human Development (RHD) have been using telepsychiatry since 2014. The teams are known as RHD Kent ACT2 and RHD New Castle ACT2 and are based in Dover and Wilmington, respectively.

For some, it may seem an odd pairing. A core aspect of ACT—a proven therapy for severe mental illness such as schizophrenia—is the idea of face-to-face contact. Multidisciplinary ACT teams meet with patients both in clinics and in their communities (at home, at work while on lunch break, or at another similar location in the community) to help patients recover and reintegrate into society.

Could this model still work if the ACT psychiatrist was present via an iPad or similar device?

“I had some concerns about telepsychiatry coming in, since I thought many clients wouldn’t want to talk to a television, but it has not been a problem at all,” said Shelley Sellinger, M.D., a New York–based psychiatrist and mental health consultant for the Kent ACT team. “A couple of patients had some wariness initially, but they warmed quickly. I even had one patient with television-related paranoia, but he was totally fine with the arrangement.”

Laura Marvel, director of RHD Kent ACT2, agreed. “It doesn’t matter if the psychiatrist is in person or on a screen,” she told Psychiatric News. “If we have access to a good doctor, it doesn’t matter where the doctor is.”

The incorporation of telepsychiatry was born out of necessity. In 2012, Delaware awarded ACT contracts to RHD to help provide better outpatient care to people with severe mental illness such as schizophrenia. RHD found out quickly that getting psychiatrists involved was difficult given the time commitments; in addition to traveling across the state to make scheduled or emergency house visits, ACT team members meet weekly to discuss patient progress.

Around that time, Dan Khebzou, an account executive with the telepsychiatry firm InSight, was meeting with RHD administrators in Philadelphia to discuss service options. He heard about the difficulties RHD was having in hiring psychiatrists for the newly formed ACT teams and suggested the telepsychiatry option.

“I’ve encountered resistance in using telepsychiatry for vulnerable populations from regulators; they cite issues such as licensing, technical problems, or handling civil commitments through video,” said Khebzou. “But Delaware was willing to embrace telepsychiatry, so it presented an opportunity to prove this model.”

After a successful pilot program, RHD moved full steam ahead with telepsychiatry in 2014, and the program is still going strong today, Marvel said. Besides patient acceptance, she said that other ACT team members—which include case coordinators, nurses, and social workers—are on board with the technology. They have not seen Sellinger’s participation via video during their weekly team meetings as hindering the team dynamic.

If anything, Sellinger said, the remote aspect can help build some relationships with the team. “I can conduct most assessments remotely as well as in person, but there are elements that are difficult, such as testing AIMS (Abnormal Involuntary Movement Scale) or rigidity,” she said. “In these cases, the on-site nurses are my eyes and ears, and we communicate about what’s going on. In addition, they will let me know about hygiene if it’s pertinent, so they also are my nose.”

There are occasional technical glitches as well, but Marvel said the teams have established back-up plans to reach Sellinger in case of some malfunction with the video monitor used in the clinic or the iPad used on the road. “I’ve found Dr. Sellinger is as accessible to me or the team as an on-site person would be,” she said. “Sometimes even more so; maybe there is a sense of overcompensating since she can’t be physically present.”

“ACT is a wonderful way to provide care to persistently ill folks who might not be able to get care otherwise,” Sellinger said. “However, it is a demanding job to go into communities every day and work with these individuals, and it can lead to psychiatrist burnout. This telepsychiatry model has allowed me to continue to practice and give care longer than I might have otherwise.”

Original article published on Psychiatric Times

Stewart Memorial Community Hospital Launches Telepsychiatry Program

Lake City, IA – Stewart Memorial Community Hospital, a general medical and surgical hospital with 25 beds, launched a telepsychiatry program this week to increase access to psychiatric care. Located in Calhoun County, Lake City is a rural area with a shortage of mental health professionals, as designated by the Rural Health Clinics Program and the Federal Office of Rural Health.[1]

Telepsychiatry is the delivery of psychiatry through real time videoconferencing. It is proven to be an effective form of care delivery and a great way to expand the psychiatric support at a hospital, especially during difficult to staff hours like nights and weekends.

In a primarily rural state such as Iowa, patients often have limited or no access to timely, affordable and quality care. This is especially prevalent in regards to psychiatric care. With telepsychiatry, emergency departments can efficiently address each patient that comes in, reduce admissions and decrease patient wait times.  Having access to telepsychiatry can also help reduce psychiatric boarding and help make sure that those admitted to psychiatric beds actually need them. This is particularly useful in Iowa which, according to the Treatment Advocacy Center, ranks second worst in the country for number of inpatient psychiatric beds with just 64 in the entire state.[2]

The telepsychiatry program is launched in partnership with InSight, a national telepsychiatry service provider organization. Telepsychiatry services are provided in the emergency department to help ensure patients struggling with mental health issues are properly treated. This gives room for other patients that come into the emergency department that may have potentially life threatening illnesses.

“Partners like Stewart Memorial Community Hospital exemplify the great impact telepsychiatry can have at a community level. Telepsychiatry has been shown to increase access to mental health care in rural areas and we’re pleased to expand that within communities like Lake City,” said InSight’s Operations Director Dena Ferrell.

“Stewart Memorial is always looking to incorporate innovative new programs that help our patients achieve a healthy mind and body. Our partnership with InSight will help better address the behavioral health needs in our community,” said Cindy Carsten, CEO of Stewart Memorial.

Stewart Memorial is served by 13 InSight telepsychiatry providers. All InSight telepsychiatry providers are licensed in Iowa and trained to provide care to Stewart Memorial patients in the same way as all onsite providers. Stewart Memorial’s partnership with InSight will help transform care in the emergency department and increase efficiency so that all patients are able to receive the care they need.

About InSight Telepsychiatry
InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through telehealth. InSight’s behavioral health providers bring care into any setting on an on-demand or scheduled basis. InSight has 18+ years of telepsychiatry experience and is an industry thought-leader. More information can be found at www.InSightTelepsychiatry.com.

About Stewart Memorial Community Hospital
Stewart Memorial is committed to quality health and wellness for you and your family. Our goal is to transform our communities by providing coordinated care and exceptional experiences.

[1] Rural Health. (n.d.). Retrieved August 07, 2017, from https://www.ruralhealthinfo.org/am-i-rural/report?lat=42.26715&lng=-94.74603&addr=1301 W Main St%2C Lake City%2C IA 51449&exact=1

[2] Fuller, D. A., Sinclair, E., Geller, J., Quanbeck, C., & Snook, J. (n.d.). Going, Going, Gone TRENDS AND CONSEQUENCES OF ELIMINATING STATE PSYCHIATRIC BEDS, 2016. Retrieved August 8, 2017, from http://www.treatmentadvocacycenter.org/storage/documents/going-going-gone.pdf

 

The Psychiatrist Shortage in Virginia

By James Varrell, MD

HOW TELEPSYCHIATRY CAN HELP

Due to trends in mental health advocacy and growing clinical evidence, people are increasingly recognizing the benefits of psychiatry and behavioral health care. For example, a 2012 study published in Contingencies measured the cost of a single employee’s depression over a two-year period prior to that employee receiving depression treatment and found the cost to the business to be as high as $3,386 per affected employee.

Unfortunately, even with a cultural shift towards addressing mental illness in Lynchburg, employers and families are struggling to get convenient and timely access to care due to a significant shortage of psychiatrists. According to the National Alliance on Mental Illness, there are over a million Virginians who experience mental illness and about 300,000 of those illnesses are classified as serious. Even with 930 psychiatrists licensed in Virginia, there simply aren’t enough providers to go around. As a psychiatrist, the demands for services can be overwhelming.

Moreover, because most psychiatrists are concentrated in Virginia’s urban pockets (Northern Virginia, the Richmond metropolitan area and Hampton Roads) many individuals outside of these areas endure long commutes to reach the nearest psychiatrist who has available appointment times. Oftentimes, getting care for oneself or a family member can be off-putting and stressful.

How Telepsychiatry Can Help
Telepsychiatry is a growing and clinically effective way to provide psychiatry, mental and behavioral health care to individuals through online video calls. Telepsychiatry can be used to provide psychiatric evaluations, consultations and treatment to individuals in various settings including outpatient offices, correctional facilities, hospitals, emergency departments, crisis centers or even in homes.

Facility-based telepsychiatry has a decent foothold in the healthcare industry. Today one of telepsychiatry’s newer applications, direct-to-consumer (D2C) telepsychiatry, is quickly becoming popular. D2C telepsychiatry allows providers to give psychiatry, mental and behavioral health care to people directly in their homes or any other private space. This takes away the stress of commuting to and from in-person offices. It also means that the time individuals and their families spend getting care is shortened to only the duration of the session, making it easier to fit into a busy schedule.

An Individual’s Experience with D2C Telepsychiatry
For example, one of my patients, whom I will call Anna, suffers from severe anxiety and depression. As a result of her disorder, Anna struggled to leave her home, and her husband, Rick, often had to take time off of work to accompany her to appointments with her psychiatrist whose office was 50 minutes away.

The stress of her appointments made Anna’s symptoms worse, negatively impacted Rick’s work and put additional strain on their family life.

It was in their search for a better care solution that Anna started to receive psychiatric medication management from me and therapy from one of my colleagues all through telepsychiatry. Anna started to access her sessions from home in the evenings after her children had gone to bed. Using telepsychiatry allowed her to receive treatment independently and the reduced stress of receiving care has empowered her and helped her to better cope with her disorder.

The Benefits of D2C Telepsychiatry

Anna’s experience is one that is shared by many Virginians who struggle to find a convenient psychiatry or behavioral health solution for themselves or their loved ones. Here are some of the many ways people can benefit from D2C telepsychiatry:
• Convenience. People can schedule appointments outside of traditional weekday hours and can easily attend sessions using any computer, tablet or smartphone in any private space with a reliable internet connection.

• Increased access to care. Telepsychiatry expands choices for providers and specialists beyond those who are within driving distance. Any provider nationwide who is licensed in the individual’s state can offer services to them. Practicing online means providers can spend more time treating people instead of traveling between offices.

• High-quality care. With more providers to pick from, people can choose the one who best fits their personality, needs and schedule. Reputable D2C telepsychiatry programs will have their providers trained to deliver telehealth appropriately and effectively.

• Privacy. Telepsychiatry is safe and secure. Some individuals prefer seeking care from the privacy of home without the fear of running into a nosy neighbor in the waiting room.

Not only does this type of treatment make it possible for people like Anna to receive care in a comfortable environment, but it also removes stress from their work and personal relationships. Telepsychiatry improves lives and is an excellent tool for increasing access to psychiatry and behavioral health care in Virginia communities.

Original story posted in Lynchburg Business Magazine.

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

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.

Telepsychiatry for Community Mental Health Centers

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InSight provides scheduled telepsychiatry services to community mental health centers, FQHCs, outpatient offices and a variety of other settings across the nation. With scheduled telepsychiatry, InSight assigns a consistent provider or small group of providers to serve a regular caseload of consumers. These providers are available in set blocks of time to do anything that a traditional in-person telepsychiatry provider would do including:

  • Assessments
  • Medication management
  • Treatment team meetings
  • Supervision
  • Other organizational needs

Access to Psychiatric Prescribers

Scheduled telepsychiatry represents reliable, consistent access to psychiatric prescribers including:

  • Psychiatric Nurse Practitioners
  • Adult Psychiatrists
  • Child and Adolescent Psychiatrists
  • Other Specialists

InSight is committed to making partner and provider matches that are a great fit. InSight recruits from a national pool of candidates and employs some of the top providers in the nation. InSight will work with your organization to understand your needs for providers with certain specialties, experience levels, cultural factors, and personality types. InSight’s providers integrate into the team and existing system of care at your organization to form collaborative relationships.

Our Approach to Partnership

By partnering with InSight for scheduled services, your organization can feel confident in the fact that it has a true partner. In addition to the implementation and ongoing support of your telepsychiatry program, InSight will bring added benefits and ongoing account management to your organization including:

  • A provider who has the experience, qualifications, schedule, personality and areas of specialty that are a good long-term fit for your program
    • Should staffing transitions or lapses in coverage arise, it will be InSight’s responsibility to fill the position
  • A robust ongoing quality assurance program that will give your organization valuable data and feedback
  • Promotional, educational and marketing support to share news about your telepsychiatry program and other hot topics
  • Telehealth regulatory and policy information and support