Tag Archives: APA

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

News on Telemental Health Services

(Original story published in Federal Telemedicine News — April 2, 2017)

Advancing critical telemental health services to help individuals with behavioral health issues was discussed at ATA’s Telehealth Capitol Connection (TCC) www.americantelemed.org briefing held on March 28, 2017. The use of technology enables mental healthcare to be delivered to major sectors of the population especially in rural areas in spite of the shortage of professionals.

Neal Neuberger as Senior Policy Consultant to ATA and moderator, opened the event by saying the use of technology in medicine has exploded since providers, patients, and employers see the advantages. However, as he pointed out, there are still policy matters that have to be addressed such privacy, finding eligible providers to deliver mental health care, and reimbursement issues.

Representative Tim Murphy (R-PA) https://murphy.house.gov Practicing Psychologist and Commander in the Naval Reserve reports, “Substance abuse and drug addiction is a major problem in this country, but the fact is that many people aren’t able to get adequate treatment fast enough because there are not enough professionals or facilities available to treat the affected population.

As reported, Congressman Murphy was able to secure an additional $15 billion in AHCA with a requirement that states must use the additional resources for mental health and addiction treatment. “We are continuing to build on our successful record to help families in the current mental health and addiction crisis. This additional $15 billion investment represents the largest surge in behavioral health funding in recent history.”

According to “Twelve percent of the 702,000 veterans have successfully received care using telehealth through the VA program”, according to John Peters, Deputy Director, Office of Connected Care, at the Department of Veteran’s Affairs, https://connectedcare.va.gov,

He reports, “Patient satisfaction for 304,000 veterans using store and forward telehealth is 94 percent, satisfaction for 307,000 veterans using video telehealth is 92 percent, and for 156,000 veterans using home telehealth, the patient satisfaction is 83 percent.”

He mentioned the bill “The Care Veterans Deserve Act of 2017” (H.R 1152) that was introduced on February 16, 2017. The bill amends the “Veterans Access Choice and Accountability Act” to make the VA’s Choice Program permanent and includes veterans with a 50 percent service connected disability.

Currently, a number of vital remote psychiatry services are available to community-based organizations, according to Geoffrey Boyce Executive Director, for InSight Telepsychiatry http://insighttelepsychiatry.com “Facing budget constraints, many community-based organizations are choosing to supplement their onsite psychiatric services with remote psychiatric prescriber teams.”

InSight is able to provide correctional facilities 24/7 access to psychiatric treatment within one hour after the request is submitted. InSight is able to respond to on-demand telepsychiatry services quickly to support an inpatient or a home setting crisis situation.

Deborah C. Baker, J.D., Director of Legal & Regulatory Policy in the Office of Legal and Regulatory Affairs, representing the American Psychological Association’s www.apa.org Practice Directorate, wants to see changes in licensing occur that would be specific to psychology.

As Baker explained, “The laws are confusing and a number of questions need to be clarified. To deal with jurisdiction issues, a few years ago, the “Psychology Interjurisdictional Compact” (PSYPACT) was introduced by the Association of State and Provincial Psychology Boards.

PSYPACT uses model language to discuss where a psychologist is physically related, where the psychologist is licensed to practice psychology, and where the client patient is physically located. Since PSYPACT is only model language, it would need to be passed in at least seven states to come into existence.

Lauren McGrath Vice President Public Policy for Centerstone, https://centerstone.org, a healthcare organization operating for 60 plus years, offers services for health homes, emergency follow-up services, integrated primary care, help for addiction, hospital and crisis services, intellectual and developmental disabilities services,  and also actively helps veterans suffering from PTSD and combat stress.

Today, Centerstone provides mobile and remote assessments in order to facilitate a quick referral for the coordination of care and appropriate treatments. The team is able to see how each person is doing by using a dashboard and if there is a problem, connections can be made by using a bidirectional app or be connected via telehealth.

— Carolyn Bloch of Bloch Consulting Group

Bloch has researched and reported on Federal government and legislative activities in the areas of science, R&D, defense, telemedicine, and health technology — and has worked with many scientific and technical newsletters, publishing firms, and other companies.

The author of 5 books and many articles based on Federal government activities, Federal funding programs, and university research grant opportunities. Carolyn Bloch has also taught courses in proposal writing for government contracts at a number of colleges and universities.

She is a member of the National Press Club, American Telemedicine Association, and the Healthcare Information and Management Systems Society (HIMSS) Maryland Chapter.

InSight Executive Director Speaks at Telemental Health Briefing on the Hill

WASHINGTON—On Tuesday, March 28, InSight Telepsychiatry’s Executive Director, Geoffrey Boyce, appeared as a guest speaker at the American Telemedicine Association’s (ATA) briefing, ‘Telehealth for Improving Mental and Behavioral Care.’

Boyce TCC

The briefing was part of ATA’s Telehealth Capitol Connection series—a bimonthly Congressional briefing for policy makers, federal agencies, national organizations and other interested stakeholders.

Boyce spoke after telemental health advocate, Rep. Tim Murphy (R-PA), about four telemental health topics—licensing, credentialing, psychiatric commitment law and prescribing—and how policies around those topics shape how InSight and other telemental health providers can deliver services.

“Telehealth is absolutely a keystone in mental health care because it allows a way to mend the shortage of providers, and provide easier and timely access for inpatient admissions and emergency care,” said Murphy. “It also just makes sense in cost savings.”

Telemental health services are growing rapidly. The VA health system estimates that they conducted 427,000 telemental health sessions in 2016 while InSight Telepsychiatry estimates conducting 150,000 telepsychiatry encounters last year.

Telehealth is addressing critical issues in the behavioral health field, such as shortages in mental health professionals, the challenge of remote care delivery, and, national struggles with suicide, PTSD, opioid addiction and other serious behavioral health issues. Some of the common settings for telemental health services are in hospital emergency departments, outpatient clinics, correctional facilities and direct-to-consumer.

“One of the things we as a practice get most excited about is the potential for telehealth to weave all of these different types of health services and sites together to really help provide care across the continuum, and have more consistency and continuity in that care,” said Boyce.

InSight is a telebehavioral health practice that began telepsychiatry encounters in emergency departments in 1999. Since then, the practice has grown to 250 providers who provide services in 27 different states in a variety of settings. Boyce leads InSight in their mission to increase access to behavioral health care by overseeing the operation of hundreds of U.S. locations every year.

Boyce was joined by fellow speakers: Rep. Tim Murphy (R-PA), John Peters, Telehealth Deputy Director at the Department of Veteran Affairs, Deborah C. Baker, J.D., Director of Legal & Regulatory Policy in the Office of Legal & Regulatory Affairs at the American Psychological Association’s Practice Directorate, and Lauren McGrath, VP of Public Policy at Centerstone.

The briefing was held at Top of the Hill Banquet & Conference Center in Washington, D.C. at 12:00 p.m.

InSight Telepsychiatry Supports Creativity and Innovation During Psychiatry Innovation Lab Event

Oct. 19, 2016 | InSight Telepsychiatry was proud to support three awards during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Washington, D.C. — InSight Telepsychiatry awarded three finalists for innovative ideas in the advancement of behavioral health care during the Psychiatry Innovation Lab at IPS: The Mental Health Services Conference organized by the American Psychiatric Association.

Chaired by psychiatrist and author Dr. Nina Vasan, the Psychiatry Innovation Lab is an educational workshop that fosters the advancement of health care delivery. The lab offers the opportunity for professionals in technology, business, medicine, government and nonprofits to connect and collaborate with psychiatrists and mental health professionals.

On Oct. 8, participants pitched ideas for the advancement of behavioral health care delivery by way of entrepreneurship, policy, systems redesign, education, collaboration, technology and more. InSight awarded a total of three of the six awards presented at the event.

A team of neuropsychiatry-minded high school students was awarded Outstanding Progress for their work on AlzHelp, an augmented-reality and intelligent personal assistant app that keeps individuals living with Alzheimer’s disease safe. The app was designed by Akanksha Jain, Michelle Koh and Priscilla Siow.

Presented by mental health care entrepreneur April Koh, Spring.com was awarded the Most Promising Innovation for enabling the prediction of treatment outcomes for depression by way of machine-learning and big data.

The last award supported by InSight went to a group called Beacon led by Shrenik Jain for the Most Disruptive Innovation. Beacon is a mobile application for chat-based group therapy that has participated in a diverse selection of health care technology initiatives. A consistent group of anonymous users come together in judgement-free communities with this group therapy app.

Other winners included: The grand prize winner Joseph Insler for his “overdose recovery bracelet” and the audience choice Swathi Krishna for SPECTRUM, an app for children with autism spectrum disorder.

As the leading national telepsychiatry organization, InSight is proud to support a workshop that cultivates the advancement of behavioral health care through innovative applications of technology. InSight provides psychiatric care through innovative applications of technology by providing telepsychiatry services to hospitals, outpatient clinics and other health care organizations nationwide.