Tag Archives: delaware

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

Telebehavioral Health Practice Launches in Delaware and New York

AUGUST 21, 2016 | Mental health providers, including psychiatrists are now available for assessment, therapy and medication management through a newly launched behavioral health practice in Delaware and New York called Inpathy. Inpathy is unique in that it operates entirely through telebehavioral health- a convenient, private and effective medium of care that is rapidly growing in popularity.

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 camera. 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 Delaware and 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
  • Lamont Josey, LCSW- a clinical social worker who offers therapy to individuals 8 years old and up and has a specialty in trauma-focused Cognitive Behavioral Therapy (CBT)
  • Humberto Quinanata, MD- a Spanish-speaking child and adolescent psychiatrist with an interest in psychopharmacology
  • Patti Rodgers, PMHNP- a board certified psychiatric nurse practitioner who serves adults and aims to educate and empower the people with whom she works
  • 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 disrders 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 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 Delaware and 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 www.Inpathy.com

Telebehavioral Health Practice Launches in Delaware

August 21, 2016 | Mental health providers, including psychiatrists are now available for assessment, therapy and medication management through a newly launched Delaware-area behavioral health practice called Inpathy. Inpathy is unique in that it operates entirely through telebehavioral health- a convenient, private and effective medium of care that is rapidly growing in popularity.

WILLMINGTON, DE Psychiatry appointments from the comfort and convenience of home are now available to Delaware residents through the launch of a new telebehavioral health practice – Inpathy.

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 Delaware and 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 the following Delaware-licensed providers:

  • Doug Ikelheimer, MD- an extremely experienced telepsychiatrist with expertise in the psychopharmacologic management of mood disorders, anxiety disorders, chronic mental illness and addictions
  • Lamont Josey, LCSW- a clinical social worker who offers therapy to individuals 8 years old and up and has a specialty in trauma-focused Cognitive Behavioral Therapy (CBT)
  • Humberto Quinanata, MD- a Spanish-speaking child and adolescent psychiatrist with an interest in psychopharmacology
  • Patti Rodgers, PMHNP- a board certified psychiatric nurse practitioner who serves adults and aims to educate and empower the people with whom she works

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 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 Delaware 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 www.Inpathy.com

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.

InSight Telepsychiatry to Present at American Telemedicine Association Annual Conference

May 15, 2016 | InSight Telepsychiatry leaders, providers and partners are presenting this week at the American Telemedicine Association’s Annual Conference and Trade Show in Minneapolis. Their presentations, which will address practicing telebehavioral health in a variety of settings and marketing telebehavioral health to consumers, will draw on InSight’s experience as the leading national telepsychiatry service provider organization.

MINNEAPOLIS — Representatives from InSight Telepsychiatry will give presentations on a variety of telepsychiatry topics during the American Telemedicine Association’s (ATA) Annual Conference and Trade Show May 15 to 17.

On May 17, two InSight providers will present during one of ATA’s 75+ peer-reviewed sessions. The session, called How-To Telemental Health in Non-Institutional Settings, will feature “Fast-Paced Work from the Comfort of Home: Clinical Considerations for Crisis Telepsychiatry,” presented by Doug Ikelheimer, MD and “ACT Now for Innovation: Develop a Telemental Health Program for ACT Teams,” presented by Shelley Sellinger, MD.

Dr. Ikelheimer, a board-certified psychiatrist, will draw on his experience as an InSight on-demand telepsychiatry provider to discuss the benefits of challenges of working in an emergency department (ED) from home.

On-demand telepsychiatry providers offer much-needed psychiatric expertise that can reduce the amount of time consumers in crisis wait for proper care. Dr. Ikelheimer’s presentation will review the steps that need to be taken to establish a successful emergency telepsychiatry program and examine case studies in which individuals were able to receive timely, appropriate care through telepsychiatry in emergency departments.

Dr. Sellinger, also a board-certified psychiatrist, will present a case study that details InSight’s partnership with Resources for Human Development (RHD) to establish a telepsychiatry program with mobile capabilities for two assertive community treatment (ACT) teams in Delaware. The program is the first in the nation to use telepsychiatry in an ACT program and serves as a model for implementing telepsychiatry into ACT programs nationwide.

The program brings a combination of on-site and in-home telepsychiatry services to individuals whose mental health conditions prevent them from working or living independently. With 4G-enabled tablets and laptops, RHD social workers to travel to individuals’ homes or other community spaces to connect them with a remote psychiatry provider.

Laura Marvel, the Unit Director for RHD’s Delaware assertive community treatment teams, will present alongside Dr. Sellinger.

InSight Marketing and Communications Manager Olivia Boyce will present the e-poster, “Telemarketing: It’s Not What You Think — A How-To Guide for Promoting Direct-to-Consumer Telehealth,” on May 15.

Additionally, InSight Business Innovations Manager Scott Baker will moderate the session, “Effectiveness of Automated Speech Recognition Apps,” on May 17. The session will focus on the use of speech recognition apps in behavioral health services, including telepsychiatry.

ATA 2016 is the industry’s leading event for insights into the latest telemedicine and mobile health trends.

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through innovative applications of technology.

For more information and to connect with InSight at ATA, visit booth 1909 or booth 515, where InSight will exhibit alongside Carenection, a telehealth marketplace that offers a scalable, unified telemedicine solution for organizations and systems implementing telehealth. To schedule a time for a meeting, contact Olivia Boyce at oboyce@in-sight.net or 770.713.4161.

InSight Applauds Changes to Delaware Telemedicine Guidelines Supporting Further Access to Behavioral Health

July 6, 2015 | Delaware recently amended its legislation to mandate parity for private insurers’ coverage of telemedicine services and to further clarify the scope of practice for several kinds of healthcare providers. The legislation was put forward and promoted by a team of leaders and regulators from several notable Delaware organizations.

With recent regulatory changes, Delaware will now require private insurers to reimburse for telemedicine services at the same rates for which they cover in-person services. They also have expanded the scope of practice provisions of telemedicine service delivery for a range of health care providers licensed in Delaware.

The changes were put forth as two amendments to House Bill 69, the “Delaware Code of Relating to Telemedicine Services,” and were sponsored by House Rep. Bryon Short and Sen. Bethany Hall-Long in the Senate. The amendments were the result of collaboration from several key players in healthcare best practices and legislation including the Delaware Medical Society, the Division of Substance Abuse and Mental Health, the Delaware House of Representatives and the Delaware Telehealth Coalition.

House Bill 69 was introduced this past March and passed by the House in early April and by the Senate in early May, both by unanimous votes. The amendment changes will go into effect January 1, 2016.

The bill synopsis cites multiple factors as motivating reasons to support and promote greater use of telemedicine and placed particular emphasis on expanded access to behavioral health services. “Geography, weather, availability of specialists, transportation, and other factors can create barriers to accessing appropriate health care, including behavioral health care, and one way to provide, ensure, or enhance access to care given these barriers is through the appropriate use of technology to allow health care consumers access to qualified health care providers.”

“The gist of the legislation really is about parity, where an office visit or a visit through your health-care professional provided through an approved electronic means is treated the same in terms of reimbursement from the insurance company,” Rep. Bryon Short, primary sponsor for the bill, said.

The other change to the telemedicine code expanded practice standards for physicians who practice telehealth as well as physician’s assistants, mental health counselors, marriage and family therapists, psychologists and several other types of health care providers as well. The amendment makes technical corrections referring to health services corporations and code references, adds the Advanced Practice Registered Nurse profession and includes definitions of several key terms for understanding telemedicine regulations.

“While the mandate for private-pay reimbursement is terrific, what stands out most about this bill is that it seeks to explicitly remove ambiguity or doubt that telemedicine is a valid form of practice for multiple professions,” Dan Khebzou, a member of the Delaware Telehealth Coalition and account executive with InSight Telepsychiatry said.

While many states have updated their language about telemedicine in the last few years, Delaware’s changes are unique in that they provide clear guidelines for appropriate use. “This bill is particularly forward thinking in that it clarifies telemedicine use for so many professions,” says Khebzou.

Delaware has been a particularly telemedicine-friendly state since House Bill 69’s first passing in 2004, but received an “F” in a 2014 study of telemedicine use under private insurance coverage by the American Telemedicine Association. The changes to this legislation demonstrates a willingness to take recommendations for improvement seriously and positions the state as a leader in the widespread adoption of a telemedicine.

Along with House Rep. Bryon Short and leadership from the Delaware Telehealth Coalition including, Andrew Wilson of the Delaware State Medical Board, Carol Morris of the Delaware Department of Health and Social Services and several other members of Delaware’s leadership organizations worked together to ensure that the language added in the amendments was sufficient and appropriate for meeting the goals of both the parties involved in writing the legislation and those of organizations and regulatory bodies who would be affected by it.

Contributions from the Delaware Medical Society ensured that the amendments stayed in line with regulations from organizations like the Division of Professional Regulation and the Delaware Department of Health and Social Services.

“The Delaware Medical Society’s support of this bill puts them ahead of the curve when compared to their peer medical societies in other states who have yet to acknowledge the inevitability of telemedicine as a rapidly-growing trend in healthcare,” said Geoffrey Boyce, Executive Director of InSight.

Delaware already has several telemedicine programs that will benefit from the changes in House Bill 69.
InSight Telepsychiatry has partnered with healthcare organizations throughout the state that have recognized an acute need for telemedicine, and particularly telepsychiatry services. The programs range from hospital emergency departments to substance use treatment facilities for children and adolescents to federally qualified health centers.

As part of a Governor’s Initiative to get more psychiatric care into underserved regions, a pilot program with several community health centers utilizes psychiatrists from InSight Telepsychiatry for psychiatric consultation.

The updated legislation will make it easier for Delaware to make decisions about incorporating other new developments in healthcare access more readily. In writing the amendments, special consideration was given to leaving room for further expansion of telemedicine use down the line while being mindful of the original scope of the bill.

“With mandated private insurance reimbursement and updated language covering the scope of practice for many health care providers, it will be easier for consumers and the providers who treat them to embrace telemedicine as a practical solution to issues of proximity and availability for appropriate healthcare services,” says Boyce.

Kent Sussex Counseling Services Utilizes Telemedicine to Enhance Patient Treatment and Streamline Psychiatric Appointments

July 26, 2012 | Delaware, like many other states, suffers from a shortage of psychiatric professionals, particularly those specializing in addictions. Recognizing this strain on organizational operations, Kent Sussex Counseling Services turned to telepsychiatry in order to improve patients’ access and experience with addiction-specific psychiatric care. Patients and providers quickly adapted to telepsychiatry and now enjoy seeing telepsychiatrist, Dr. Christina Vaglica on screen.

The Delaware Rural Health Initative (DRHI) Annual Conference Emphasized Telemedicine As a Tool for Increasing and Improving Behavioral Healthcare

June 1, 2012 | Over 140 people attended the annual conference entitled “Continuing the Journey Towards Access & Excellence in the Southern Delaware Mental Health System.” Medical, governmental, educational, and business leaders updated attendees on innovations in relevant Delaware healthcare realms. The conference served as the forum for Secretary of the Department of Health and Social Services Rita Landgraf to officially announce that Delaware will begin to reimburse for telemedicine starting July 1. In the spirit of this announcement, many of the presentations, including one from leaders at InSight Telepsychiatry, stressed technology as a tool for improving rural health care.