Tag Archives: ACT

Telepsychiatry: What to Look for in 2018

By: Geoffrey Boyce

Geoffrey Boyce, Executive Director of InSight Telepsychiatry

Originally published on Behavioral Healthcare Executive

In the world of telehealth, what a difference a few years can make. The industry has moved from burgeoning to mainstream and is seen as a viable model for behavioral healthcare. In fact, industry professional shortages are catapulting adoption and use of telepsychiatry to address unmet psychiatric needs in all states.

The field of telepsychiatry has much to celebrate in recent years, and the outlook ahead is brighter than ever. Here are five top predictions about where telepsychiatry is headed in 2018.

  1. Growth of direct-to-consumer telepsychiatry

Consumerism is taking healthcare by storm as individuals demand greater access, convenience and empowerment in their care choices. It’s why the American Telemedicine Association recently named uptake of consumer-driven technology as one of the top five trends for the telemedicine market in 2018.

Thus, it’s understandable why the “anywhere, anytime” access of telepsychiatry continues to drive growth of direct-to-consumer models. As individuals embrace the ability to access care at home or other comfortable locations where a reliable Internet connection exists, continued evolution of this trend is expected.

Consumers will increasingly recognize the advantages of heightened availability that enables scheduling of sessions outside of traditional office hours. Many increasingly find that video-conferencing models tear down communication barriers and reduce stigma—a key factor that otherwise keeps many from seeking behavioral health treatment. Additionally, individuals can look outside of local referral networks to access services, expanding provider options and consumer choice.

  1. Increased access through policy/legislation and coverage

Perhaps there is no greater confirmation of telemedicine’s positive impact on care delivery than recent policy and legislation developments. The clear majority of states have enacted or proposed some form of parity regarding insurance coverage of telemedicine.

This activity will likely continue as demand for greater access to behavioral health services soars and stakeholders recognize the benefits of telepsychiatry models.

Additionally, in efforts to address the growing opioid epidemic, President Donald Trump earlier this year declared a public health emergency, calling for expanded telehealth access for Americans in need of care. Telehealth is a valuable solution to help improve care and the overall outlook around this significant public health crisis. To ensure that the addiction and mental healthcare disciplines continue to advance and embrace telehealth, and in turn, increase access to much needed services surrounding this crisis, it will be important for states to closely monitor and enact legislation that considers all types of telehealth. For example, language written to curb the prescribing of schedule II drugs via telehealth might extend to the best-practice prescribing of medication for children with ADHD via telepsychiatry, causing unintended limitations.

  1. Positioning for value-based care

The premise of value-based care is higher quality, better outcomes and lower costs. Industry stakeholders increasingly recognize that care delivery must address the whole health of individuals—both physical and behavioral—to achieve sustainable “value.” Individuals are best engaged in their care plans and overall wellness when behavioral health is addressed in tandem with physical illness.

As providers and employers embrace this reality, they are finding that telepsychiatry effectively addresses fragmentation that often exists across the behavioral health continuum. Timely access to behavioral health services—whether emergent or ongoing—improves continuity of care and mitigates the need for higher cost interventions. Especially in multifaceted cases with complex pharmacology, video consultations improve access to multi-disciplinary treatment teams and direct telepsychiatry interventions to improve monitoring and provide ongoing patient engagement.

  1. Increased adoption of connected community models

In synch with positioning for value-based care, healthcare communities will continue to see growth of connected community models in 2018. This will be especially evident in progressive communities that recognize the need for a comprehensive, sustainable and multifaceted behavioral health strategy that increases access to care across the continuum.

For instance, communities will continue to realize notable gains in the coming year by integrating telepsychiatry across multiple settings including:

  • Emergency departments (EDs): ED physicians often lack the psychiatric resources needed for timely evaluations of critical-need patients. Telepsychiatry helps by speeding up access and ensuring quick triage to the most appropriate level of care.
  • Primary care: More than half of all psychiatric drugs today are prescribed by non-psychiatrists due to provider shortages. Telepsychiatrists can provide attractive referral options or a consultative partnership to primary care providers.
  • Community-based care settings: Mental health clinics and other community-based organizations often struggle to retain and recruit local psychiatrists. Telepsychiatry brings long-term access to psychiatry providers who are the best fit for an organization’s needs.
  • Inpatient units or residential program: Inpatient units or residential programs benefit from additional psychiatric support to make sure a unit has 24/7 coverage and consultative support.
  • Medical/surgical floors of hospitals: Medical floors of hospitals often need psychiatric consultations or evaluations to ensure providers are fully treating the patient’s comprehensive health.
  • Discharge planning: Telepsychiatry ensures timely continuation of services for discharge planners in need of referral options, where waiting lists in some clinics can reach upwards of 10 weeks.
  1. New settings embracing telepsychiatry

The industry is also witnessing significant uptake and use of telepsychiatry in areas outside of the healthcare setting as community organizations recognize the advantages. A few examples of new settings include:

  • Community agencies and correctional facilities: These organizations are increasingly engaging with telepsychiatrists to improve access to psychiatric evaluation and treatment.
  • Crisis response teams: mobile mental health crisis teams are leveraged to assist individuals in need, offer assessment and decide the best course of action. By bringing telepsychiatrists with them virtually with a tablet or mobile device, the situation can be assessed and managed in real time.
  • Assertive Community Treatment (ACT) teams: Designed as an intensive and highly-integrated approach, ACT teams support better transitions from hospital environments for individuals who are re-entering the community. Telepsychiatrists can attend home visits along with case managers virtually with a tablet or mobile device.
  • Schools and universities: Young people need convenient, timely access to mental health services, often requiring specialty providers that are difficult to find. Telepsychiatry is a great solution for meeting students where they are with the right resources.

Looking ahead, the opportunities for leveraging telepsychiatry in new settings are endless as communities creatively address behavioral health needs. The telemedicine industry has come a long way in just a few years, and great momentum exists going in to 2018.

 

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

Innovative ACT Program Utilizing Telepsychiatry to Be Highlighted at American Telemedicine Association Annual Conference

May 17, 2016 | Representatives from Resources for Human Development and InSight Telepsychiatry will discuss a first-of-its-kind program that brings telepsychiatry to individuals with severe mental illness receiving care through assertive community treatment programs in Delaware.

InSight RHD

Speakers representing Resources for Human Development (RHD) and InSight Telepsychiatry will highlight their unique use of telepsychiatry in two Delaware assertive community treatment (ACT) programs at the American Telemedicine Association Annual Conference on May 17.

InSight telepsychiatrist Shelley Sellinger, MD, and RHD’s Unit Director in Delaware Laura Marvel will present a case study detailing the organizations’ development of a telepsychiatry program for RHD’s ACT teams in Wilmington and Dover, Del., the first program of its kind in the nation. Marvel, who has spent the past 15 years working in Delaware’s mental health system, was a driving force behind the creation of the program. Dr. Sellinger provides 32 hours of scheduled telepsychiatry services per week to RHD’s Dover program from her home office in New York.

Using 4G-enabled laptops and tablets, RHD social workers can bring remote telepsychiatry providers directly to the homes of individuals with severe mental illness participating in RHD’s ACT programs. These in-home visits are used in conjunction with office visits where a telepsychiatrists is also a part of the care team.

ACT programs bring together counselors, psychiatrists, registered nurses, case managers and vocational specialists to help individuals whose mental health conditions cause them significant challenges in working, maintaining social relationships, living independently and managing their health. These providers work with individuals to identify what is preventing them from living a successful life and facilitate independence. The ACT model of care was developed in the early 1970s and was widely adopted in communities across the countries by the end of the decade.

In 2012, Delaware awarded ACT contracts in Dover and Wilmington to RHD, a national human services nonprofit organization, with the goal of discharging consumers from inpatient units and providing them with intensive, 24/7 outpatient care. However, Delaware’s shortage of available psychiatry providers, which reflects national shortages, made it challenging for members RHD’s ACT provider team to come together regularly.

To address this problem, RHD took a unique approach, partnering with InSight the next year to incorporate telepsychiatry into their ACT programs.

The two organizations created a telepsychiatry pilot with two groups of 100 individuals, who were transported to RHD’s two ACT offices to meet with a psychiatrist via videoconference. By using telepsychiatry, RHD maintains a team approach to care, and psychiatry providers maximize the number of individuals they see, since they no longer have to spend time traveling from site to site.

Once RHD and InSight established the efficacy and acceptability of telepsychiatry with individuals in the office-based pilot program, they expanded the program to be able to meet individuals in the community. Instead of bringing individuals to see a telepsychiatrist in their offices, RHD could bring the telepsychiatrist to individuals in their homes or other community spaces using 4G-enabled laptops and tablets.

Today, RHD’s Delaware ACT programs use telepsychiatry both in and outside of their offices. Dr. Sellinger sees individuals in their homes a few times a week via telepsychiatry. She says that iPads have helped increase the volume of in-home telepsychiatry encounters and that individuals love it when she comes to them via the devices.

Seeing individuals in their home environments helps more accurately assess their needs, says Dr. Sellinger. “When you see them in their home, you see if it’s clean or messy, and their family is there,” Dr. Sellinger says. “You really get a sense of what’s going on with them.”

Dr. Sellinger can then use these environmental and social cues as clinical indicators to help her prescribe the best possible treatment for that particular individual.

“Despite the fact that individuals and Dr. Sellinger do not meet in the same location, both parties tend to forget that they’re seeing each other through screens,” says Kathleen Gainey, a registered nurse at RHD’s ACT office in Dover who works with Dr. Sellinger. “It’s as if she’s there in person,” she says of Dr. Sellinger and her ability to connect with individuals.

In-home telepsychiatry from InSight isn’t limited to ACT programs. InSight’s Inpathy network makes it possible for consumers to connect with behavioral health professionals, including many psychiatrists from home.

InSight and RHD’s ATA presentation will take place on May 17 at 4:15 p.m. in room 205A.

InSight will also have two booths at ATA, booth 1909 and booth 515.

For more information, to connect with InSight at ATA, or to schedule a time for a meeting with an InSight representative, contact Olivia Boyce at oboyce(at)in-sight(dot)net or 770.713.4161.