Ensuring Successful Telepsychiatry Program Implementation: Critical Components and Considerations

Presenting a Framework for Telebehavioral Health Implementation

PURPOSE OF REVIEW

This paper presents OPTIC as a framework to guide the conceptualization and implementation of telebehavioral health (TBH) in a comprehensive, structured, and accessible manner.

RECENT FINDINGS

There is a need for comprehensive frameworks for TBH implementation, yet current models and frameworks described in the literature have limitations. Many studies highlight favorable outcomes of TBH during COVID-19, along with increased adoption. However, despite the plethora of publications on general telehealth implementation, knowledge is disparate, inconsistent, not comprehensive, and not TBH-specific. The framework incorporates five components: Originating site, Patient population, Teleclinician, Information and communication technologies, and Cultural and regulatory context. These components, abbreviated using the acronym OPTIC, are discussed, with examples of implementation considerations under each component throughout the project cycle. The value and larger implications of OPTIC are discussed as a foundation for stakeholders involved with TBH, in addition to key performance indicators, and considerations for quality enhancement.

A review of evaluation approaches for telemental health programs

PURPOSE

Although studies have examined the effectiveness of telemental health programs, optimal approaches for their evaluation remain unclear. We sought to review the outcomes used to evaluate telemental health programs.

METHODS

We conducted a literature search in PubMed and Google Scholar for peer-reviewed studies published between January 2010 until October 2019, and we excluded review articles, opinion papers, presentations, abstracts, and program report without data.

RESULTS

1310 articles were identified, 34 of which were reviewed. Studies used a combination of non-clinical and clinical outcomes, most commonly engagement and impact rates, and standardised clinical measures. Very few studies examined technological feasibility, cost-effectiveness, and qualitative satisfaction reports.

CONCLUSIONS

This review is the first to summarise approaches to evaluate telemental health programs. Strengths and weaknesses of the evaluation outcomes are discussed in this review, highlighting essential factors that should be taken into consideration when developing a standardised framework for the evaluation of future telemental health programs.KEY POINTSThe methods used to evaluate telemental health programs are varied and no gold-standard for measurement of success exists.Clinical and non-clinical outcomes are being used to evaluate telemental health programs.More emphasis should be placed on feasibility measures such as cost-effectiveness.Therapeutic alliance should be a crucial part of evaluation of any telemental health program.Longer follow up times and larger sample sizes, as well as more diverse populations, are needed to generalise outcomes.Utilisation of clinical tools to assess success should be limited to standardised measures commonly used in clinical practice.

Tele-Mental Health Utilization Among People with Mental Illness to Access Care During the COVID-19 Pandemic

Shortly after the COVID-19 pandemic arrived at the United States, mental health services moved towards using tele-mental health to provide care. A survey about resilience and tele-mental health was developed and conducted with ForLikeMinds' members and followers. Correlational analysis was used to examine relationships between quantitative variables. A phenomenological approach was used to analyze open questions responses. Sixteen percent of participants were coping well with the pandemic; 50% were coping okay; and 34% said that they were coping poorly. Three main themes emerged from the qualitative analysis: accessibility to care; self-care strategies; and community support and relationship. The responses from participants seems to reflect the combination of two main factors-the challenges they were facing in accessing care through tele-mental health plus the mental health consequences from COVID-19. This survey reflects the importance of building innovative strategies to create a working alliance with people who need care through tele-mental health.

Guidelines for primary health care-based telemental health in a low-to middle-income country: the case of Lebanon

Significant efforts have been conducted to improve access to Mental Health Services (MHS) and reduce the burden of Mental Health Disorders (MHD) in Low-to Middle-Income Countries (LMIC). However, important challenges to accessing MHS still exist and limit improvements. Telemental Health (TMH), a modality that delivers remote MHS provides an ideal solution to complement existing efforts; however, there are limited reports on its implementation in developing countries such as Lebanon. This study presents the first roadmap for TMH applicability in Lebanon, with a focus on the Primary Health Care (PHC) setting, which has international relevance. We review existing guidelines and contextualise them to the Lebanese setting by addressing essential components for implementation. In specific, we shed light on 6 aspects: (1) patient population, (2) technological guidelines, (3) clinical guidelines, (4) administrative guidelines, (5) workforce, and (6) monitoring and evaluation. In addition, we acknowledge the important role of governmental efforts in setting the infrastructural and regulatory aspects for TMH practice. We provide guidance for public health professionals, government officials, and clinicians looking to adopt TMH practice in Lebanon or other countries with similar development and cultural landscapes.

Planning and Implementing Telepsychiatry in a Community Mental Health Setting: A Case Study Report

Healthcare institutions in the United States are increasingly adopting telehealth services given their numerous benefits in enhancing access to care. Despite that, few accounts of such organizational experiences in the literature exist, especially those pertaining to telepsychiatry. In this case study, we report the planning and implementation of a telepsychiatry program adopted by a community mental health organization in suburban Chicago, Illinois from 2017 until 2019. We analyze findings gathered from the organization's secondary archival data, highlighting process and outcome evaluations of the program. Results show high levels of patient engagement compared to in-person service modality. Also, our results show an increase in the number of patients served, efficiency in service delivery, decreases in patient wait time to accessing services, and overall positive feedback from patients, families, and staff members. We discuss the successes and challenges encountered by the organization and synthesize them into practical applications recommended for similar initiatives.