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Mishkind M, Shore JH, Barrett R, Caudill R, Chiu A, Hilty D, Idigo OB, Kaftarian E, Khan S, Krupinski EA, Malik TS, Thackaberry J, Torous J, Yellowlees P. Resource Document on Best Practices in Synchronous Videoconferencing-Based Telemental Health. Telemed J E Health 2024; 30:1330-1340. [PMID: 38054938 DOI: 10.1089/tmj.2023.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Background: This document represents an updated collaboration between the American Psychiatric Association (APA) and the American Telemedicine Association (ATA) to create a consolidated update of the previous APA and ATA official documents and resources in telemental health, to provide a single guide on clinical best practices for providing mental health services through synchronous videoconference. Methods: A joint writing committee drawn from the APA Committee on Telepsychiatry and the ATA TMH Special Interest Group (TMH SIG). was convened to draft and finalize the guidelines. This document draws directly from the 2018 APA/ATA guide and the ATA s previous guidelines, selecting from key statements/guidelines, consolidating them across documents, and then updating them where indicated. Guideline approval was provided following internal review by the APA, the ATA, the Board of Directors of the ATA, and the Joint Reference Committee of the APA. Results: The guidelines contain requirements, recommendations, and actions that are identified by text containing the keywords "shall," "should," or "may." Conclusions: Compliance with these recommendations will not guarantee accurate diagnoses or successful outcomes. The purpose of this guide is to assist providers in providing effective and safe medical care founded on expert consensus, research evidence, available resources, and patient needs.
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Affiliation(s)
- Matt Mishkind
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jay H Shore
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Raymond Barrett
- Telehealth Certification Institute, LLC, Blacksburg, Virginia, USA
| | - Robert Caudill
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | | | - Don Hilty
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
| | | | | | - Shabana Khan
- NYU Grossman School of Medicine, New York, New York, USA
| | | | | | | | - John Torous
- Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA
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2
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Wibberly KH. Preparing mental health providers for the future: the case for moving beyond the elective telehealth course to integrating telehealth training throughout the curriculum. Front Psychol 2024; 14:1301569. [PMID: 38235285 PMCID: PMC10792033 DOI: 10.3389/fpsyg.2023.1301569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/01/2023] [Indexed: 01/19/2024] Open
Abstract
In the wake of the COVID-19 Public Health Emergency and the consequent surge in telehealth adoption, the mental healthcare landscape has undergone a profound transformation propelled by rapid technological advancements. This paradigm shift necessitates a fundamental re-evaluation of the training methodologies for mental health providers. To effectively leverage the potential of telehealth and empower mental health professionals with the requisite skills for utilizing digital tools, a comprehensive integration of telehealth into graduate program curricula is imperative. This article proposes practical strategies for seamlessly incorporating telehealth into both the theoretical and practical facets of graduate education. These strategies encompass a holistic understanding of technological platforms, ethical considerations, legal and regulatory frameworks, cultural competence, digital equity challenges, as well as clinical assessment and therapeutic approaches. The author concludes by issuing a call to action, urging mental health professions training programs and their accrediting bodies to proactively redefine their approach, ensuring mental health providers are adequately prepared for the future.
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Affiliation(s)
- Kathy Hsu Wibberly
- Karen S. Rheuban Center for Telehealth, University of Virginia School of Medicine, Charlottesville, VA, United States
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3
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Cho S, Kang J, Baek WH, Jeong YB, Lee S, Lee SM. Comparing counseling outcome for college students: Metaverse and in-person approaches. Psychother Res 2023:1-14. [PMID: 37848177 DOI: 10.1080/10503307.2023.2270139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
ABSTRACTObjective This study compared metaverse counseling with in-person counseling, using in-person counseling as a comparison group. To achieve this, we assessed whether metaverse counseling, a novel treatment approach, is comparable to traditional in-person counseling. Method: A total of 60 participants voluntarily participated in the study. Among the participants, 28 preferred in-person counseling, whereas 32 selected metaverse counseling as their preferred treatment option. Results and Conclusion: The findings indicated no statistically significant differences in the psychological symptom change patterns between the two counseling modalities. Both metaverse and in-person counseling demonstrated a common pattern of reduced symptom levels from pre-to post-session (Metaverse counseling Cohen's d = 1.04, In-person counseling Cohen's d = .62), which remained stable from post-session to follow-up regardless of the chosen counseling modality. Furthermore, the study revealed that the metaverse counseling group exhibited a higher level of working alliances than the in-person counseling group. Additionally, there was a slight tendency toward higher levels of counseling satisfaction in the metaverse counseling group than in the in-person counseling group. The results of this study support the use of synchronous metaverse programs to treat college students. The implications and limitations of this study are discussed. (195 words).
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Affiliation(s)
- Soohyun Cho
- Department of Education, Keimyung University, Daegu, Korea
| | - Jieun Kang
- Department of Education, Korea University, Seoul, Korea
| | - Woo Hyun Baek
- Department of Education, Korea University, Seoul, Korea
| | | | | | - Sang Min Lee
- Department of Education, College of Education, Korea University, Seoul, Korea
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DeLaCruz-Jiron EJ, Hahn LM, Donahue AL, Shore JH. Telemental Health for the Homeless Population: Lessons Learned when Leveraging Care. Curr Psychiatry Rep 2023; 25:1-6. [PMID: 36480149 PMCID: PMC9734763 DOI: 10.1007/s11920-022-01400-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to review key lessons when using telehealth within the context of mental health and homelessness. We examine technological and bandwidth issues the homeless population might face when getting telehealth services, discuss clinical process adaption needed for working remotely, and highlight the lessons learned when leveraging mental health services to homeless patients across telehealth platforms. RECENT FINDINGS Homelessness is associated with chronic, mental health disparities and access to mental health services is often less accessible among communities with unstable housing. Telehealth provides "OnDemand" treatment options while removing specific barriers found with in-person health care such as transportation, overwhelmed mental health facilities, i.e., appointment availability, and office hour limitations while reducing costs for both providers and patients. We provide two case examples to demonstrate successful delivery of telemental health services to homeless patients and review lessons learned when leveraging care.
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Affiliation(s)
| | - Lauren M. Hahn
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Amy L. Donahue
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA
| | - Jay H. Shore
- Access Management Services LLC, 11100 East Bethany Drive, Aurora, CO 80014 USA ,Department of Psychiatry and Family Medicine, School of Medicine and Centers for American Indian and Alaska Native Health Colorado School of Public Health, Anschutz Medical Campus, Aurora, USA
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5
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Abouzid MR, Elshafei SM, Elkhawas I, Elbana MK. Applications of Telemedicine in the Middle East and North Africa Region: Benefits Gained and Challenges Faced. Cureus 2022; 14:e26611. [PMID: 35936169 PMCID: PMC9355518 DOI: 10.7759/cureus.26611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 11/05/2022] Open
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6
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Novella JK, Ng KM, Samuolis J. A comparison of online and in-person counseling outcomes using solution-focused brief therapy for college students with anxiety. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1161-1168. [PMID: 32703092 DOI: 10.1080/07448481.2020.1786101] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/21/2020] [Accepted: 06/12/2020] [Indexed: 05/20/2023]
Abstract
ObjectiveThis study compared online, synchronous video counseling to in-person counseling using solution-focused brief therapy for college students with mild to moderate anxiety. Participants: Participants were 49 undergraduate students who were seeking counseling for mild to moderate anxiety. The study was conducted from November, 2017 to December 2018. Methods: In a randomized, non-inferiority design, undergraduate participants were randomly assigned to online, synchronous video counseling or in-person treatment for anxiety using solution-focused brief therapy (SFBT). Participants completed the Beck's Anxiety Inventory (BAI) and College Counseling Assessment of Psychological Symptoms (CCAPS) to assess outcomes. Results: The results showed significant changes in scores on the BAI and the CCAPS Generalized Anxiety and Social Anxiety subscales for participants in both study conditions, and no significant differences in effectiveness of the two delivery methods. Conclusions: The findings provide support for the treatment of college students with anxiety with SFBT through online, synchronous video counseling. Limitations related to sample size and diversity are discussed.
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Affiliation(s)
| | - Kok-Mun Ng
- Counseling, Oregon State University, Corvallis, OR, USA
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Colombo P, Busti Ceccarelli S, Pacchiarini S, Cribellati S, Molteni M. MedicalBIT: A web platform for Standardized Data Acquisition, Processing and Export in Child Psychopathology Clinical Routine. From design to implementation. (Preprint). JMIR Form Res 2022; 6:e36757. [PMID: 35816380 PMCID: PMC9315902 DOI: 10.2196/36757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background The rapid extent of digital innovation for the collection of data has transformed the way in which health professionals collect, share, and analyze health information for better clinical decision-making and health care. In the last decade, there has been an increased interest in telemedicine by mental health agencies; the gap between the need for care and both diagnosis and treatment is wide, and digital technology could play an important role in filling this gap. However, there are limited data on the effectiveness of the clinical process and cost-effectiveness of most telemedicine applications. Objective This study examined the implementation of the first Italian online, web-based, comprehensive screening tool and described the screening and diagnostic process through the interactive web platform in a child psychopathology clinic. This is a feasibility study that aims to present the design and implementation of the best practices to improve patient experiences and clinical outcomes. Moreover, the paper evaluates the platform with qualitative and quantitative measures. Methods We planned, designed, and implemented a web-based system to collect, store, and manage clinical data. The platform was developed by a multidisciplinary team composed of researchers, clinicians, and informatics professionals through different steps. First, we defined the clinical information to be collected. A number of measures were chosen, tapping several clinical risk areas such as neurodevelopmental disorders and emotional and behavioral problems. The web application architecture and process were then designed. The three phases of process design are described in detail: design of the input interface, processing design, and design of the output interface. Finally, the system has been implemented and evaluated. Based on indicators recommended by the National Quality Forum and the Italian National Guidelines, we evaluated the quality of the system and used quantitative measures that were replicable and comparable over time. Results We present the implemented architecture and features of Medea Information and Clinical Assessment On-Line (MedicalBIT), and we provide performance measures for the data collected between October 2018 and June 2021. The measured concepts pertain to four domains: access to care, financial impact/cost, experience, and effectiveness. Conclusions In this study, we present the successful implementation of an innovative digital tool. The findings of this study show that the implemented web-based platform appears to be an efficient, cost-effective, and feasible way to improve digital care in the field of child psychiatry.
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Affiliation(s)
- Paola Colombo
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
| | - Silvia Busti Ceccarelli
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
| | | | | | - Massimo Molteni
- Child Psychopathology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Eugenio Medea, Bosisio Parini, Italy
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8
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Shaughnessy L, Brunton S, Chepke C, Farmer JG, Rosenzweig AS, Grossberg G. Using Telemedicine to Assess and Manage Psychosis in Neurodegenerative Diseases in Long-Term Care. J Am Med Dir Assoc 2022; 23:1145-1152. [PMID: 35032454 PMCID: PMC8752392 DOI: 10.1016/j.jamda.2021.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/29/2021] [Accepted: 12/11/2021] [Indexed: 11/04/2022]
Abstract
The coronavirus disease 2019 (COVID-19) epidemic has forced a sudden global implementation of telemedicine strategies, including in long-term care (LTC) facilities where many people with dementia and Parkinson disease (PD) reside. Telemedicine offers a unique set of advantages for residents in LTC facilities if effectively supported and implemented, including expanded access to specialists in rural or underserved areas or for people with dementia who cannot travel for off-site visits. Many medical and psychiatric organizations have recently issued new or updated guidelines on the use of telemedicine. On October 22, 2020, a multidisciplinary consensus panel was convened to collate a list of best practices for LTC facilities and specialists when conducting telemedicine with residents with dementia-related psychosis or PD-related psychosis (PDP). A collaborative effort between specialists, facility administrators, and facility staff is essential for the success of telemedicine in the LTC setting. Telemedicine in LTC facilities comes with increased administrative and technical challenges that fall heavily on the shoulders of the LTC facility administrators and staff. Specialists can ease this burden by maintaining flexibility and ensuring expression of empathy and thanks to the staff who are facilitating the visits. LTC staff can provide specialists with valuable information about their patients to aid in evaluation and diagnosis. Specialists can facilitate this exchange of information by speaking to staff who work closely with the resident about any signs of hallucinations or delusions they may have observed. Educational efforts can increase staff understanding of dementia and PDP and empower them to engage with, and facilitate the resident's treatment plan. Using these strategies to take advantage of the benefits of telemedicine, specialists and LTC staff can together expand and improve care for LTC facility residents with dementia-related psychosis or PDP.
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Affiliation(s)
- Lynn Shaughnessy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA; Touro University, Vallejo, CA, USA
| | - Craig Chepke
- Excel Psychiatric Associates and University of North Carolina School of Medicine, Huntersville, NC, USA
| | - Jill G Farmer
- Parkinson's Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA; Drexel College of Medicine, Philadelphia, PA, USA
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Bulkes NZ, Davis K, Kay B, Riemann BC. Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. J Psychiatr Res 2022; 145:347-352. [PMID: 34799124 PMCID: PMC8595951 DOI: 10.1016/j.jpsychires.2021.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 12/13/2022]
Abstract
The heightened acuity in anxiety and depressive symptoms catalyzed by the COVID-19 pandemic presents an urgent need for effective, feasible alternatives to in-person mental health treatment. While tele-mental healthcare has been investigated for practicability and accessibility, its efficacy as a successful mode for delivering high-quality, high-intensity treatment remains unclear. This study compares the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192). Outcomes are measured with respect to depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report; QIDS-SR) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Q-LES-Q). There were no significant differences in admission score on either assessment comparing in-person and telehealth groups. Patients in the partial hospitalization level of care stayed longer when treatment was remote. Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups. Future research is needed to replicate these findings in other healthcare organizations in other geographical locations and diverse patient populations.
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10
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SILVA NHLPD, OTTOLIA RF, MARQUES LG, ANTÚNEZ AEA. Use of digital technologies in mental health during COVID-19. ESTUDOS DE PSICOLOGIA (CAMPINAS) 2022. [DOI: 10.1590/1982-0275202239e200225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Most countries did not have a consolidated digital health structure before the pandemic. Both social distancing and mental health problems resulting from the situation justify the urgency of discussions on web-mediated interventions. The objective of this work is to present the panorama of technological mediation in mental health services and their specificities in the context of the pandemic. This paper is grounded on a critical look at the migration from face-to-face care to the Internet environment, highlighting: the international experiences using digital technologies in the pandemic context; the challenges in online consultations, emphasizing the importance of the ethical, technical/technological, and clinical domains, which are recurring issues in the international literature; the challenges and perspectives in the use of technologies. It is essential to develop strategies aligned with government incentives, aiming at the quality of the offered services and the guarantee of an adequate hybrid qualification.
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11
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Utilization of telemedicine in orthopaedic surgery during the COVID-19 pandemic: a review of elbow examination and assessment. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Sharma A, Feuer V, Stuart BK, Folk JB, Doan BT, Kulkarni CA, Ramtekkar U, Fortuna L, Myers K. Home-Based Telemental Health: A Proposed Privacy and Safety Protocol and Tool. J Child Adolesc Psychopharmacol 2021; 31:464-474. [PMID: 34543079 DOI: 10.1089/cap.2021.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Seattle Children's Hospital, Seattle, Washington, USA
| | - Vera Feuer
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Barbara Krishna Stuart
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Bridget T Doan
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Chetana A Kulkarni
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Hospital for Sick Children (SickKids), Toronto, Canada
| | - Ujjwal Ramtekkar
- Department of Psychiatry and Behavioral Health, The Ohio State University School of Medicine, Columbus, Ohio, USA.,Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lisa Fortuna
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Haidous M, Tawil M, Naal H, Mahmoud H. A review of evaluation approaches for telemental health programs. Int J Psychiatry Clin Pract 2021; 25:195-205. [PMID: 33243045 DOI: 10.1080/13651501.2020.1846751] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Mohammad Haidous
- Department of Internal Medicine, St. Vincent Charity Medical Center, Cleveland, OH, USA
| | - Michel Tawil
- Department of Pathology and Laboratory Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Hossam Mahmoud
- Clinical Assistant Professor, Tufts University School of Medicine, Boston, MA
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14
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Kitaigorodsky M, Loewenstein D, Curiel Cid R, Crocco E, Gorman K, González-Jiménez C. A Teleneuropsychology Protocol for the Cognitive Assessment of Older Adults During COVID-19. Front Psychol 2021; 12:651136. [PMID: 34054655 PMCID: PMC8155705 DOI: 10.3389/fpsyg.2021.651136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic prompted the need for a teleneuropsychology protocol for the cognitive assessment of older adults, who are at increased risk for both COVID-19 and dementia. Prior recommendations for teleneuropsychological assessment did not consider many of the unique challenges posed by COVID-19. The field is still in need of clear guidelines and standards of care for the assessment of older adults under the current circumstances. Advantages of teleneuropsychological assessment during the COVID-19 pandemic include reduced risk of contracting the virus, eliminating travel time and reducing cost, and more rapid access to needed services. Challenges include disparities in technology access among patients, reduced control over the testing environment, impeded ability to make behavioral observations, and limited research on valid and reliable cognitive assessment measures. The aim of this perspective review is to propose a teleneuropsychological protocol to facilitate neuropsychological assessment utilizing a virtual platform. The proposed protocol has been successful with our clinical and research populations and may help neuropsychologists implement teleneuropsychology services without compromising validity or reliability. However, there is increasing need for research on teleneuropsychological assessment options for both clinical and research purposes.
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Affiliation(s)
- Marcela Kitaigorodsky
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - David Loewenstein
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Rosie Curiel Cid
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Katherine Gorman
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Christian González-Jiménez
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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16
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Tele-Mental Health Utilization Among People with Mental Illness to Access Care During the COVID-19 Pandemic. Community Ment Health J 2021; 57:720-726. [PMID: 33566269 PMCID: PMC7873669 DOI: 10.1007/s10597-021-00789-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/29/2021] [Indexed: 02/07/2023]
Abstract
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.
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17
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Fernández-Álvarez J, Fernández-Álvarez H. Videoconferencing Psychotherapy During the Pandemic: Exceptional Times With Enduring Effects? Front Psychol 2021; 12:589536. [PMID: 33679513 PMCID: PMC7933024 DOI: 10.3389/fpsyg.2021.589536] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/12/2021] [Indexed: 12/16/2022] Open
Abstract
With the advent of COVID-19, a sudden, unexpected, and forced shift has been produced in the field of psychotherapy. Worldwide, many therapists closed their offices and started to deliver psychotherapy online through a screen. Although different media started to be incorporated, videoconferencing is undoubtedly the most common way in which therapists are doing therapy these days. This is catalyzing a rapid change in the practice of psychotherapy with probable lasting effects and deserves to be carefully reflected upon. Therefore, in this paper our aim is to outline the main challenges for a medium that may have arrived to stay. In that sense, we review the literature to describe the state-of-the-art regarding the main aspects of videoconferencing psychotherapy as well as to suggest possible avenues for future research and practice.
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Affiliation(s)
- Javier Fernández-Álvarez
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón de la Plana, Spain
- Asociación Aiglé, Valencia, Spain
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18
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Hewson T, Robinson L, Khalifa N, Hard J, Shaw J. Remote consultations in prison mental healthcare in England: impacts of COVID-19. BJPsych Open 2021; 7:e49. [PMID: 33551008 PMCID: PMC7870917 DOI: 10.1192/bjo.2021.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Telemedicine has become increasingly used by prison mental health services throughout the COVID-19 pandemic. In this editorial, we explore the benefits and risks of the remote provision of forensic mental healthcare, with consideration of the clinical, financial, ethical and legal consequences.
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Affiliation(s)
- Thomas Hewson
- Academic Clinical Fellow in Psychiatry at the Health Education North West School of Psychiatry and the University of Manchester, UK
| | - Louise Robinson
- Consultant Forensic Psychiatrist Lancashire and South Cumbria NHS Foundation Trust and an Honorary Senior Lecturer in forensic psychiatry in the Division of Psychology and Mental Health at the University of Manchester, UK
| | - Najat Khalifa
- Associate Professor in Forensic Psychiatry in the Department of Psychiatry and Centre for Neuroscience Studies at Queen's University, Kingston, Ontario, and regional psychiatry lead (Ontario) in Correctional Service Canada
| | - Jake Hard
- General Practitioner with over 13 years of experience working in prisons in the UK and is the Chair of the Royal College of General Practitioners Secure Environments Group, London, UK
| | - Jennifer Shaw
- Professor of Forensic Psychiatry in the Division of Psychology & Mental Health at the University of Manchester, UK, Consultant Forensic Psychiatrist and academic lead for the Offender Health Research Network. She is also a member of the Independent Advisory Panel on Deaths in Custody, UK
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19
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Hilty DM, Armstrong CM, Edwards-Stewart A, Gentry MT, Luxton DD, Krupinski EA. Sensor, Wearable, and Remote Patient Monitoring Competencies for Clinical Care and Training: Scoping Review. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:252-277. [PMID: 33501372 PMCID: PMC7819828 DOI: 10.1007/s41347-020-00190-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 01/21/2023]
Abstract
Sensor, wearable, and remote patient monitoring technologies are typically used in conjunction with video and/or in-person care for a variety of interventions and care outcomes. This scoping review identifies clinical skills (i.e., competencies) needed to ensure quality care and approaches for organizations to implement and evaluate these technologies. The literature search focused on four concept areas: (1) competencies; (2) sensors, wearables, and remote patient monitoring; (3) mobile, asynchronous, and synchronous technologies; and (4) behavioral health. From 2846 potential references, two authors assessed abstracts for 2828 and, full text for 521, with 111 papers directly relevant to the concept areas. These new technologies integrate health, lifestyle, and clinical care, and they contextually change the culture of care and training-with more time for engagement, continuity of experience, and dynamic data for decision-making for both patients and clinicians. This poses challenges for users (e.g., keeping up, education/training, skills) and healthcare organizations. Based on the clinical studies and informed by clinical informatics, video, social media, and mobile health, a framework of competencies is proposed with three learner levels (novice/advanced beginner, competent/proficient, advanced/expert). Examples are provided to apply the competencies to care, and suggestions are offered on curricular methodologies, faculty development, and institutional practices (e-culture, professionalism, change). Some academic health centers and health systems may naturally assume that clinicians and systems are adapting, but clinical, technological, and administrative workflow-much less skill development-lags. Competencies need to be discrete, measurable, implemented, and evaluated to ensure the quality of care and integrate missions.
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Affiliation(s)
- Donald M. Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Department of Psychiatry & Behavioral Sciences, UC Davis, 10535 Hospital Way, Mather, CA 95655 (116/SAC) USA
| | - Christina M. Armstrong
- Department of Veterans Affairs, Connected Health Implementation Strategies, Office of Connected Care, Office of Health Informatics, Washington, DC USA
| | | | - Melanie T. Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN US
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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20
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Cen SS, Yu J, Wang Q, Deeb W, Wang KL, Shukla AW, Malaty I, Ramirez-Zamora A, Zhang JG, Hu W, Meng FG. Multidisciplinary Telemedicine Care for Tourette Syndrome: Minireview. Front Neurol 2021; 11:573576. [PMID: 33391146 PMCID: PMC7775481 DOI: 10.3389/fneur.2020.573576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Tourette syndrome (TS) is a childhood-onset, chronic neuropsychiatric disorder characterized by multiple motor and vocal tics. TS poses a considerable burden on both patients and health care providers, leading to a major detriment of educational success, occupation, and interpersonal relationships. A multidisciplinary, specialist-driven management approach is required due to the complexity of TS. However, access to such specialty care is often dramatically limited by the patients' locations and the specialists' geographic clustering in large urban centers. Telemedicine uses electronic information and communication technology to provide and support health care when distance separates participants. Therefore, we conducted this mini-review to describe the latest information on telemedicine in the assessment and management of TS and discuss the potential contributions to care for TS patients with a multidisciplinary approach. We believe that telemedicine could be a revolutionary method in improving medical access to patients with TS.
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Affiliation(s)
- Shan-Shan Cen
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Jun Yu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Qiao Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wissam Deeb
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States.,Department of Neurology, University of Massachusetts, Worcester, MA, United States
| | - Kai-Liang Wang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aparna Wagle Shukla
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Irene Malaty
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Hu
- Program in Movement Disorders and Neurorestoration, Department of Neurology, Fixel Institution for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Fan-Gang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Chinese Institute for Brain Research, Beijing, China
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21
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Implementation of telehealth services for inpatient psychiatric Covid-19 positive patients: A blueprint for adapting the milieu. Gen Hosp Psychiatry 2021; 68:113-114. [PMID: 32972728 PMCID: PMC7481799 DOI: 10.1016/j.genhosppsych.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
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22
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Simpson S, Richardson L, Pietrabissa G, Castelnuovo G, Reid C. Videotherapy and therapeutic alliance in the age of COVID-19. Clin Psychol Psychother 2020; 28:409-421. [PMID: 33037682 PMCID: PMC7675483 DOI: 10.1002/cpp.2521] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/23/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022]
Abstract
The arrival of the coronavirus (COVID‐19) pandemic has confronted us with a global and unprecedented challenge of community‐wide psychological distress alongside reduced access to therapeutic services in the traditional face‐to‐face format, due to the need to self‐isolate. This previously unimagineable set of circumstances provides a unique opportunity, and indeed an imperative, for videotherapy to fulfil its potential in addressing mental health and well‐being needs from a distance. Historically, the uptake of videotherapy has been hindered by psychotherapist expectations of inferior therapeutic alliance and outcomes, in spite of considerable research evidence to the contrary. Research suggests that videotherapy provides a powerful pathway for clients to experience enhanced opportunities for self‐expression, connection and intimacy. This more neutral therapeutic ‘space’ provides clients with multifarious opportunities for self‐awareness, creative experience and collaboration, with potentially a greater sense of agency over their own experience. This paper explores ways in which videotherapy can lead to a revitalisation of the concept of the therapeutic relationship, in order to meet the challenges associated with COVID‐19. A number of specific considerations for videotherapy adaptations and etiquette in the midst of COVID‐19 are described.
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Affiliation(s)
- Susan Simpson
- NHS Lothian, St. John's Hospital, Livingston, UK.,Department of Justice & Society, University of South Australia, Adelaide, SA, Australia
| | - Lisa Richardson
- North Metropolitan Health Service, MHPHDS, Perth, WA, Australia
| | - Giada Pietrabissa
- Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Corinne Reid
- Deputy Vice Chancellor, Research, Victoria University, Melbourne, VIC, Australia
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23
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Hilty DM, Gentry MT, McKean AJ, Cowan KE, Lim RF, Lu FG. Telehealth for rural diverse populations: telebehavioral and cultural competencies, clinical outcomes and administrative approaches. Mhealth 2020; 6:20. [PMID: 32270012 PMCID: PMC7136658 DOI: 10.21037/mhealth.2019.10.04] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rural health care settings are challenged to provide timely and evidence-based care, particularly for culturally diverse patients with behavioral health disorders. Telepsychiatry and telebehavioral health improve access to care and leverage scarce resources. This scoping review from January 2000 - July 2019 was conducted to see if the literature had data for two related the research questions, "What are the components of culturally competent, telepsychiatric clinical care, and what approaches have clinicians and systems taken to implement and evaluate it?" The review focused on key words in four concept areas: (I) competencies; (II) telehealth in the form of telepsychiatry, telebehavioral or telemental health; (III) culture; and (IV) health. It was done in accordance with the six-stage scoping review process in PubMed/Medline and other databases. The screeners reviewed the full-text articles for final inclusion based on inclusion (mesh of the key words) and exclusion (e.g., need for only, skills abstractly discussed) criteria. From a total of 1,118 papers, the authors found 44 eligible for full text review and found 7 papers directly relevant to the concepts. Few studies specifically discuss skills and competencies of both telehealth and cultural factors. Many organizations are attending to cultural competencies and approaches to care, but there are no specific competencies that integrate telepsychiatry or telebehavioral health with culture. Existing telepsychiatric (i.e., video, social media, mobile health) and one set telebehavioral health competencies included cultural component, including use of interpreters and language matters. Administrative adjustments are suggested to promote culturally competent care by telehealth via clinical, educational, quality improvement, program/system evaluation, and other (e.g., finance and reimbursement) interventions. More structured research is needed on development, implementation and evaluation of combined competencies in rural settings.
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Affiliation(s)
- Donald M. Hilty
- Northern California Veterans Administration Health Care System, Mather, CA 95655, USA
- Department of Psychiatry & Behavioral Sciences, UC Davis, Mather, CA 95655, USA
| | - Melanie T. Gentry
- Geriatric Psychiatry Fellowship, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Alastair J. McKean
- Department of Psychiatry, Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
| | - Kirsten E. Cowan
- Essentia Health and Child Psychiatrist Affiliated with Mayo Clinic Department of Psychiatry and Psychology, Hinckley, MN 55037, USA
| | - Russell F. Lim
- Emeritus Clinical Professor of Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
| | - Francis G. Lu
- Clinical Psychiatry & Behavioral Sciences, Emeritus Luke & Grace Kim Professor in Cultural Psychiatry, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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24
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Giansanti D. Towards the evolution of the mHealth in mental health with youth: the cyber-space used in psychological rehabilitation is becoming wearable into a pocket. Mhealth 2020; 6:18. [PMID: 32270010 PMCID: PMC7136651 DOI: 10.21037/mhealth.2019.11.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/25/2019] [Indexed: 02/01/2023] Open
Abstract
The study is focused into the field of tele-mental health with youth. It has three polarities. The first polarity consists on the analysis of the state of art of the guide-lines and reports the recent situation depicted by the American Telemedicine Association and the American Psychiatric Association. The second polarity faces the recent evolution related to the tools available in mHealth to activate remote psychological rehabilitation processes. These tools are today also based on a wearable cyberspace comprehending virtual (VR) and augmented reality (AR). The third polarity concludes the study by opening and submitting basic questions on the related activity of the stake-holders, scholars, regulation bodies and workgroups and showing some example of this activity.
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25
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Ensuring Successful Telepsychiatry Program Implementation: Critical Components and Considerations. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00208-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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26
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Gardner JS, Plaven BE, Yellowlees P, Shore JH. Remote Telepsychiatry Workforce: a Solution to Psychiatry's Workforce Issues. Curr Psychiatry Rep 2020; 22:8. [PMID: 31989417 DOI: 10.1007/s11920-020-1128-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW The purpose of this paper is to demonstrate how a remote workforce may increase access to care while reducing physician burnout. We review workforce issues and organizational and individual obstacles for implementing a telepsychiatry workforce including administrative, logistical, and clinical considerations and offer resources for how to overcome barriers that may arise in implementing a remote workforce. RECENT FINDINGS There is an increasingly unmet demand for mental health services and a shortage in psychiatrists. Burnout may be a key factor contributing to psychiatrists working less, pursuing less acute cases, and leading to worsened outcomes for patients and the psychiatrists themselves. Telepsychiatry provides comparable patient and provider satisfaction and equal outcomes when compared with face-to-face encounters. We provided 3 case examples to demonstrate psychiatrists demonstrating successful delivery of care in a range of clinic settings and workplace configurations while optimizing their quality of life and reducing their risk of burnout.
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Affiliation(s)
| | - Brittany E Plaven
- Walden University, Minneapolis, USA.,Department of Health Professions, Metropolitan State University of Denver, Denver, USA
| | | | - Jay H Shore
- AccessCare, 11100 E. Bethany Dr., Aurora, CO, 80014, USA.,Department of Psychiatry and Family Medicine, School of Medicine, Centers for American Indian and Alaska Native Health, Colorado School of Public Health, Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, USA
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27
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Stoll J, Sadler JZ, Trachsel M. The Ethical Use of Telepsychiatry in the Covid-19 Pandemic. Front Psychiatry 2020; 11:665. [PMID: 32760299 PMCID: PMC7371958 DOI: 10.3389/fpsyt.2020.00665] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/26/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Julia Stoll
- Faculty of Medicine, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
| | - John Z Sadler
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Manuel Trachsel
- Faculty of Medicine, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Clinical Ethics Unit, University Hospital Basel and University Psychiatric Clinics Basel, Basel, Switzerland
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28
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Lee H, Kim J, Kim S, Kong HJ, Ryu H. Investigating the Need for Point-of-Care Robots to Support Teleconsultation. Telemed J E Health 2019; 25:1165-1173. [DOI: 10.1089/tmj.2018.0255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hyeongsuk Lee
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Jeongeun Kim
- College of Nursing, Seoul National University, Seoul, Republic of Korea
- Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Sukwha Kim
- Department of Reconstructive Plastic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hyeongju Ryu
- College of Nursing, Seoul National University, Seoul, Republic of Korea
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29
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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30
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Zhao X, Innes KE, Bhattacharjee S, Dwibedi N, LeMasters TM, Sambamoorthi U. Facility and state-level factors associated with telemental health (TMH) adoption among mental health facilities in the United States. J Telemed Telecare 2019; 27:244-257. [PMID: 31475879 DOI: 10.1177/1357633x19868902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Telemental health (TMH) is a promising approach to increase access to mental healthcare. This study examined the TMH adoption rates and associations with facility- and state-level factors among US mental health (MH) facilities. METHODS This retrospective, cross-sectional study used linked data for 2016 from the National Mental Health Services Survey (N = 11,833), Area Health Resources File, and national reports for broadband access and telehealth policies. The associations of facility and state-level characteristics with TMH adoption were examined with multi-level logistic regressions. RESULTS Overall, 25.9% had used TMH. Having veteran affiliation [Adjusted Odds Ratio (AOR) = 18.53, 95% Confidence Interval (95%CI): 10.66-32.21] and greater Information Technology (IT) capacity [AOR(95%CI): 2.89(2.10-3.98)] were the strongest correlates of TMH adoption. Other facility characteristics associated with higher likelihood of TMH adoption were: public ownership, high patient volumes, having comprehensive MH treatments or Quality Improvement practices, having private or non-Medicaid public payers, and treating elderly patients (AORs: 1.16-2.41). TMH adoption was less likely among facilities treating more African Americans or patients with substance abuse disorders. TMH adoption varied substantially across states, with adoption more likely in states issuing special telehealth licences and those with more rural counties. DISCUSSION One in four MH facilities adopted TMH in 2016. TMH adoption varied by multiple facility- and state-level factors. Our findings suggest that: legal/regulatory burden and lower facility IT capacity may discourage TMH adoption; significant racial disparities exist in TMH adoption; and there is a need to increase TMH use for substance abuse disorders.
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Affiliation(s)
- Xiaohui Zhao
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Kim E Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice & Science, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Traci M LeMasters
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA
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Schoenfelder Gonzalez E, Myers K, Thompson EE, King DA, Glass AM, Penfold RB. Developing home-based telemental health services for youth: Practices from the SUAY Study. J Telemed Telecare 2019; 27:110-115. [PMID: 31342851 DOI: 10.1177/1357633x19863208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There are no published procedural or safety guidelines for home-based telemental health (TMH) therapy with youth, despite the unique challenges and risks of providing services to this population outside of a traditional clinic setting. We developed clinical, logistical, and safety procedures for home-based TMH with youth in the context of a large clinical trial. METHODS A Targeted Approach to Safer Use of Antipsychotics in Youth (SUAY) study identifies youth ages 3-17 who are prescribed second-generation antipsychotic medication for non-psychotic disorders within large healthcare systems. Prescribing physicians receive psychopharmacology consultation. Patients receive a "navigator" to coordinate treatments and access to TMH if they do not have a local therapist. We optimized access by allowing TMH sessions to take place in the family's home, while providing guidelines for privacy, safety, and in-session crises. RESULTS Clinical issues included providing flexibility in the treatment modality and engaging families. Logistical issues included remote consenting for treatment and troubleshooting technological problems. Safety issues included crisis and safety planning with the youth and family before and during treatment. DISCUSSION The provision of home-based TMH therapy for youth requires adaptations to existing TMH procedural and safety guidelines to optimize clinical care, technology coordination, and safety.Trial registration number and trial register: Clinicaltrials.gov: NCT03448575.
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Affiliation(s)
- Erin Schoenfelder Gonzalez
- University of Washington School of Medicine; Seattle, WA USA.,Center for Children's Health, Behavior, and Development, Seattle Children's Hospital, Seattle WA USA
| | - Kathleen Myers
- University of Washington School of Medicine; Seattle, WA USA.,Center for Children's Health, Behavior, and Development, Seattle Children's Hospital, Seattle WA USA
| | - Ella E Thompson
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Deborah A King
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Ashley M Glass
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute; Seattle, WA USA
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Victor AM. Telepsychiatry and comprehensive mental health India. Perspect Psychiatr Care 2019; 55:459-463. [PMID: 30479029 DOI: 10.1111/ppc.12342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Telemedicine in psychiatry is a validated and effective practice of medicine that increases access to health care. Telepsychiatry is also termed as telemental health or E-mental health using video conferencing which is broadly defined to provide and support psychiatric mental health services across distances. The consumption of knowledge in the mental health field has been renowned sporadically since the sixth decade of the last century. PRACTICE IMPLICATIONS It is imperative for nurses to see the telehealth technology as a medium for care, and not a tool to replace high-quality nursing practices. Patient safety will be maintained with telenurses who are able to focus on patient care and not the technology itself.
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Affiliation(s)
- Agnes Monica Victor
- Psychiatric and Mental Health Nursing Department, College of Nursing, King Saud bin Abdulaziz University for Health Sciences (MC 3105), Riyadh, Kingdom of Saudi Arabia
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Abstract
The delivery of teletherapy is an important advancement in clinical care for the treatment of eating disorders (EDs). Specifically, it seems to improve access to highly specialized ED treatment. Research on the application of videoconferencing-based psychotherapy services for EDs is minimal; however, results suggest that this treatment format leads to significant improvements in clinical symptoms and is well accepted by patients. General telemedicine guidelines and administrative and clinical recommendations specific to the treatment of ED patients have been identified. With careful planning and thoughtful application, Internet-based therapy seems to be a valuable resource for practitioners seeking to disseminate specialized ED treatments.
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Mahmoud H, Vogt EL, Sers M, Fattal O, Ballout S. Overcoming Barriers to Larger-Scale Adoption of Telepsychiatry. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20181228-02] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gilmore AK, Ward-Ciesielski EF. Perceived risks and use of psychotherapy via telemedicine for patients at risk for suicide. J Telemed Telecare 2019; 25:59-63. [PMID: 28990454 PMCID: PMC5940577 DOI: 10.1177/1357633x17735559] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Suicide is a major public health problem and its human, emotional, and economic costs are significant. Individuals in rural areas are at highest risk for suicide. However, telemedicine services are typically not rendered to individuals who are actively suicidal. The goals of the current study were to identify the risks of using telemedicine for mental healthcare from the perspective of licensed mental health providers and to determine factors associated with the use of telemedicine with patients who are at high risk for suicide. METHODS A total of 52 licensed mental health providers were recruited online through several professional organization listservs and targeted emails. Providers completed online questionnaires regarding demographics, caseload of suicidal patients, perceived risks for using telemedicine with patients at risk for suicide, attitudes towards telemedicine, and use of telemedicine with patients at risk for suicide. RESULTS Three key perceived risks associated with using telemedicine were identified, including assessment, lack of control over patient, and difficulties triaging patients if needed. It was also found that individuals who had more positive attitudes towards telemedicine, younger providers, and more experienced providers were more likely to use telemedicine with patients who are at high risk for suicide. DISCUSSION To our knowledge, this is the first study to examine the perceived risks and use of telemedicine with patients at high risk for suicide. It is essential to continue this line of research to develop protocols for the provision of evidence-based therapy via telemedicine for this high-risk group.
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Affiliation(s)
- Amanda K Gilmore
- 1 National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
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Shore JH, Yellowlees P, Caudill R, Johnston B, Turvey C, Mishkind M, Krupinski E, Myers K, Shore P, Kaftarian E, Hilty D. Best Practices in Videoconferencing-Based Telemental Health April 2018. Telemed J E Health 2018; 24:827-832. [PMID: 30358514 DOI: 10.1089/tmj.2018.0237] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telemental health, in the form of interactive videoconferencing, has become a critical tool in the delivery of mental health care. It has demonstrated the ability to increase access to and quality of care, and in some settings to do so more effectively than treatment delivered in-person. This article updates and consolidates previous guidance developed by The American Telemedicine Association (ATA) and The American Psychiatric Association (APA) on the development, implementation, administration, and provision of telemental health services. The guidance included in this article is intended to assist in the development and delivery of effective and safe telemental health services founded on expert consensus, research evidence, available resources, and patient needs. It is recommended that the material reviewed be contemplated in conjunction with APA and ATA resources, as well as the pertinent literature, for additional details on the topics covered.
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Affiliation(s)
- Jay H Shore
- 1 Helen and Arthur E. Johnson Depression Center, the University of Colorado Anschutz Medical Campus , Aurora, Colorado.,2 Department of Psychiatry, the University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Peter Yellowlees
- 3 Department of Psychiatry, University of California , Davis, Sacramento, California
| | - Robert Caudill
- 4 Department of Psychiatry, The University of Louisville School of Medicine , Louisville, Kentucky
| | | | - Carolyn Turvey
- 6 Department of Psychiatry, Carver College of Medicine, The University of Iowa , Iowa City, Iowa
| | - Matthew Mishkind
- 1 Helen and Arthur E. Johnson Depression Center, the University of Colorado Anschutz Medical Campus , Aurora, Colorado
| | - Elizabeth Krupinski
- 7 Department of Radiology and Imaging Sciences, Emory University School of Medicine , Atlanta, Georgia
| | - Kathleen Myers
- 8 Center for Child Health , Behavior, and Development, Seattle Children's Hospital, Seattle, Washington
| | - Peter Shore
- 9 Portland Veterans Affairs Health Care System , Portland, Oregon
| | | | - Donald Hilty
- 11 Northern California Veterans Affairs Health Care System , Sacramento, California
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Talal AH, McLeod A, Andrews P, Nieves-McGrath H, Chen Y, Reynolds A, Sylvester C, Dickerson SS, Markatou M, Brown LS. Patient Reaction to Telemedicine for Clinical Management of Hepatitis C Virus Integrated into an Opioid Treatment Program. Telemed J E Health 2018; 25:791-801. [PMID: 30325701 DOI: 10.1089/tmj.2018.0161] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and Introduction: Virtual integration of hepatitis C virus (HCV) infection management within the opioid treatment program (OTP) through telemedicine may overcome limited treatment uptake encountered when patients are referred offsite. To evaluate the diffusion of telemedicine within the OTP, we conducted a pilot study to assess acceptance of and satisfaction with telemedicine among 45 HCV-infected opioid use disorder (OUD) patients on methadone. Materials and Methods: We administered a modified 11-item telemedicine satisfaction questionnaire after the initial HCV telemedicine evaluation, when initiating HCV treatment, and 3 months post-HCV treatment completion. Among a patient subset, a semistructured interview further assessed issues of participant referral to the telemedicine program as well as convenience and confidentiality with the telemedicine encounters. Results: Patients demonstrated their acceptance of telemedicine-based encounters by referral of additional participants. They highlighted the convenience of on-site treatment with a liver specialist through recognition of the benefit of "one-stop shopping." They also expressed confidence in the privacy and confidentiality of telemedicine encounters. Discussion: In this pilot study, telemedicine appears to be well accepted as a modality for HCV management among OUD patients on methadone. Virtual integration of medical and behavioral therapy through telemedicine warrants further investigation for its use in this population. Conclusions: In this pilot study, we found that a largely racial minority population of substance users grew to accept telemedicine over time with diminished privacy and confidentiality concerns. Telemedicine was well accepted within the OTP community as reflected by participant referral to the program.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York
- START Treatment & Recovery Centers, Brooklyn, New York
| | | | | | - Heidi Nieves-McGrath
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Yang Chen
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
| | | | | | - Suzanne S Dickerson
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, State University of New York, Buffalo, New York
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Moving towards novel multidisciplinary approaches for improving elderly quality of life: The emerging role of telemedicine in Sicily. J Telemed Telecare 2018; 25:318-324. [DOI: 10.1177/1357633x17753057] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Elderly care is a worldwide social and economic challenge for the public health system, and it requires the development of new management strategies. Telemedicine provides an innovative approach towards elderly care, especially for those with chronic diseases. In this study, we aimed to evaluate the potential role of a multidisciplinary telemedicine approach for improving elderly quality of life. Methods Twenty-two participants received weekly vital parameter monitoring and nutritional counselling, biweekly psychological counselling and a monthly consultation with a neurologist. The neuropsychological assessment included the Mini Mental State Examination, the Activities of Daily Living, the Instrumental Activities of Daily Living, the Geriatric Depression Scale and the Short-Form Health Survey, and was administered at enrolment (T0) and at the end of the study (T3). The nutritional evaluation included haematochemical examinations of glycaemia, total cholesterol, and triglycerides at baseline (T0) and every four months (T1, T2, T3). Results Significant differences in Activities of Daily Living, Geriatric Depression Scale and all domains of the Short-Form Health Survey were observed between baseline and the end of the study. The haematochemical parameters showed obvious changes over time, especially in cholesterol values, and the patients with hypercholesterolaemia and hypertriglyceridaemia showed a reduction in body mass index. Moreover, we found that the haematochemical values were moderately correlated with the Activities of Daily Living, Geriatric Depression Scale and Short-Form Health Survey scores. Conclusion Telemedicine can be a suitable tool for caring for elderly people more efficiently by promoting the remission of depressive symptoms and improving social functioning, cognitive levels and nutritional habits to prevent vascular diseases and exacerbations of pre-existing chronic illness.
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Clinical Update: Telepsychiatry With Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2017; 56:875-893. [PMID: 28942810 DOI: 10.1016/j.jaac.2017.07.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/17/2017] [Indexed: 01/17/2023]
Abstract
This Clinical Update reviews the use of telepsychiatry to deliver psychiatric, mental health, and care coordination services to children and adolescents across settings as direct service and in collaboration with primary care providers or other clinicians. The update defines terms and presents the current status of telepsychiatry as a mode of health service delivery. The update presents procedures for conducting telepsychiatry services and optimizing the clinical experience.
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Myers K, Nelson EL, Rabinowitz T, Hilty D, Baker D, Barnwell SS, Boyce G, Bufka LF, Cain S, Chui L, Comer JS, Cradock C, Goldstein F, Johnston B, Krupinski E, Lo K, Luxton DD, McSwain SD, McWilliams J, North S, Ostrowski J, Pignatiello A, Roth D, Shore J, Turvey C, Varrell JR, Wright S, Bernard J. American Telemedicine Association Practice Guidelines for Telemental Health with Children and Adolescents. Telemed J E Health 2017; 23:779-804. [DOI: 10.1089/tmj.2017.0177] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Eve-Lynn Nelson
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Department of Pediatrics, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Terry Rabinowitz
- Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, Vermont
- Department of Family Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Donald Hilty
- Psychiatry & Addiction Medicine, Kaweah Delta Medical Center, UC Irvine Affiliate, Visalia, California
- Department of Psychiatry, Keck School of Medicine at University of Southern California, Los Angeles, California
- Research and Health Services, Aligned Telehealth, Calabasas, California
| | - Deborah Baker
- Office of Legal and Regulatory Affairs, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sara Smucker Barnwell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Seattle Psychology PLLC, Seattle, Washington
| | | | - Lynn F. Bufka
- Practice Research and Policy, Practice Directorate, American Psychological Association, Washington, District of Columbia
| | - Sharon Cain
- Child and Adolescent Psychiatry Division, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Lisa Chui
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Jonathan S. Comer
- Center for Children and Families, Florida International University, Miami, Florida
- Mental Health Interventions and Technology (MINT) Program, Florida International University, Miami, Florida
| | | | | | | | - Elizabeth Krupinski
- Department of Radiology & Imaging Sciences, Emory University, Atlanta, Georgia
| | - Katherine Lo
- Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington
| | - David D. Luxton
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
- Office of Forensic Mental Health Services, State of Washington, Olympia, Washington
| | - S. David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- Department of Telehealth Optimization, Medical University of South Carolina, Charleston, South Carolina
| | | | - Steve North
- Center for Rural Health Innovation, Spruce Pine, North Carolina
- Mission Virtual Care, Spruce Pine, North Carolina
| | - Jay Ostrowski
- Behavioral Health Innovation, Charlotte, North Carolina
| | - Antonio Pignatiello
- TeleLink Mental Health Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David Roth
- Mind and Body Works, Inc., Honolulu, Hawaii
| | - Jay Shore
- Department of Psychiatry, Center for American Indian and Alaska Native Health, University of Colorado, Denver, Colorado
- Telepsychiatry Committee, American Psychiatric Association, Arlington, Virginia
| | - Carolyn Turvey
- Department of Psychiatry, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Shawna Wright
- KU Center for Telemedicine & Telehealth, University of Kansas Medical Center, Kansas City, Kansas
- Wright Psychological Services, Chanute, Kansas
| | - Jordana Bernard
- American Telemedicine Association, Washington, District of Columbia
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Vander Stoep A, McCarty CA, Zhou C, Rockhill CM, Schoenfelder EN, Myers K. The Children's Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2017; 45:27-43. [PMID: 27117555 DOI: 10.1007/s10802-016-0155-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The Children's Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 - 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β = -1.41, 95 % CI = [-2.74, -0.08], p < .05), PSI (β = -4.59, 95 % CI = [-7.87, - 1.31], p < .001), CSQ (β = -5.41, 95 % CI = [- 8.58, -2.24], p < .001) and FES (β = 6.69, 95 % CI = [2.32, 11.06], p < .01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.
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Affiliation(s)
- Ann Vander Stoep
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA. .,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA. .,Department of Epidemiology, University of Washington School of Public Health, Box 357236, Seattle, WA, 98195, USA.
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Pediatrics, University of Washington School of Medicine, Box 356320, Seattle, WA, 98195, USA
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Pediatrics, University of Washington School of Medicine, Box 356320, Seattle, WA, 98195, USA.,Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA, 98195, USA
| | - Carol M Rockhill
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
| | - Erin N Schoenfelder
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
| | - Kathleen Myers
- Center for Child Health, Behavior, and Development, Seattle Childrens' Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 356560, Seattle, WA, USA
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Sibley MH, Comer JS, Gonzalez J. Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017; 39:467-485. [PMID: 28989230 PMCID: PMC5625835 DOI: 10.1007/s10862-017-9598-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.
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Affiliation(s)
- Margaret H. Sibley
- Department of Psychiatry and Behavioral Health, Florida International University, Miami, FL
| | - Jonathan S. Comer
- Department of Psychology, Florida International University, Miami, FL
| | - Jaife Gonzalez
- Center for Children and Families, Florida International University, Miami, FL
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Saeed SA, Johnson TL, Bagga M, Glass O. Training Residents in the Use of Telepsychiatry: Review of the Literature and a Proposed Elective. Psychiatr Q 2017; 88:271-283. [PMID: 27796920 DOI: 10.1007/s11126-016-9470-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Many regions in the United States are deficient in mental health services, especially those in rural areas. As a result of these deficiencies, many patients in need of psychiatric services are often left untreated. Although it is clear that telepsychiatry has great potential in improving patient access to mental health care in areas where psychiatric services are deficient, the lack of familiarity with the technology and inadequate training are current barriers to expanding the use of telepsychiatry. A review of telepsychiatry, its clinical applications, and evidence-based literature regarding competencies in graduate medical education related to telepsychiatry are provided. An approach to implementing telepsychiatry into a curriculum is suggested. We also propose an elective clinical experience with resources for didactics or independent study that will enable residents to develop a knowledge base and competence in the practice of telepsychiatry.
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Affiliation(s)
- Sy Atezaz Saeed
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 600 Moye Blvd., Suite 4E-102, Greenville, NC, 27834, USA.
| | - Toni L Johnson
- Department of Psychiatry and Behavioral Medicine, Psychiatric Outpatient Clinic, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
| | - Mandeep Bagga
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
| | - Oliver Glass
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine at East Carolina University, 905 Johns Hopkins Drive, Greenville, NC, 27834, USA
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Mermelstein H, Guzman E, Rabinowitz T, Krupinski E, Hilty D. The Application of Technology to Health: The Evolution of Telephone to Telemedicine and Telepsychiatry: A Historical Review and Look at Human Factors. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s41347-017-0010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gros DF, Lancaster CL, López CM, Acierno R. Treatment satisfaction of home-based telehealth versus in-person delivery of prolonged exposure for combat-related PTSD in veterans. J Telemed Telecare 2016; 24:51-55. [PMID: 27672059 DOI: 10.1177/1357633x16671096] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Although there is growing support that evidence-based psychotherapies (EBPs) delivered in-person and through telehealth are equivalent in terms of symptom reduction for posttraumatic stress disorder (PTSD), there has been far less investigation comparing these treatment modalities in terms of patient satisfaction. The present study investigated participant satisfaction and perception of the quality of service delivery within a clinical trial comparing the delivery of an EBP, Prolonged Exposure (PE) for PTSD, through home-based telehealth and in-person services. Methods Veterans ( N = 67) with PTSD were randomized to receive PE via video telehealth technology ( n = 27) or via in-person delivery ( n = 40). Participants completed service demographic questions, PTSD symptom assessments, and satisfaction and service delivery perception questionnaires. Results Analyses of covariance were used to investigate the influence of treatment modality on patient satisfaction and perceived quality of service delivery, while controlling for demographics and PTSD symptoms. No differences were observed on the majority of measures, with the exception of participants in the telehealth condition endorsing willingness to drive further for telehealth services as compared with participants in the in-person condition. Discussion Findings illustrate participant satisfaction and acceptance of EBPs delivered via telehealth at a level consistent with that of in-person services. Preliminary findings suggest that the experience of receiving telehealth services may be associated with increased willingness to participate in telehealth services again. Together, these findings of patient satisfaction and acceptance of telehealth services support the ongoing delivery of EBPs via telehealth as well as their future expansion.
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Affiliation(s)
- Daniel F Gros
- 1 Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, USA.,2 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | - Cynthia Luethcke Lancaster
- 1 Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, USA.,2 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, USA
| | | | - Ron Acierno
- 1 Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, USA.,3 College of Nursing, Medical University of South Carolina, USA
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Shore J. The evolution and history of telepsychiatry and its impact on psychiatric care: Current implications for psychiatrists and psychiatric organizations. Int Rev Psychiatry 2016; 27:469-75. [PMID: 26397182 DOI: 10.3109/09540261.2015.1072086] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We have reached a critical convergence in psychiatry between the changing systems of health care structure and funding, our evolution into a technology-based society, and growth in the science and delivery of psychiatric treatments. Fostered by this convergence is the maturation over the past two decades of telepsychiatry, in the form of live interactive video conferencing, as a critical tool to improve access, increase quality and reduce costs of psychiatric treatment. This article reviews the history and evolution of telepsychiatry including implications for the field in order to provide individual psychiatrists and psychiatric organizations guidance on how to formulate current and strategic directions. This article begins with a broad overview of the history of medicine providing contextualization of the development of the field of telepsychiatry. It concludes with projected trends and recommendations.
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Affiliation(s)
- Jay Shore
- a University of Colorado Anschutz Medical Campus, Helen and Arthur E. Johnson Depression Center , Aurora, Colorado , USA
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47
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Abstract
Most children and adolescents across the USA fail to receive adequate mental health services, especially in rural or underserved communities. The supply of child and adolescent psychiatrists is insufficient for the number of children in need of services and is not anticipated to grow. This calls for novel approaches to mental health care. Telemental health (TMH) offers one approach to increase access. TMH programmes serving young people are developing rapidly and available studies demonstrate that these services are feasible, acceptable, sustainable and likely as effective as in-person services. TMH services are utilized in clinical settings to provide direct care and consultation to primary care providers (PCPs), as well as in non-traditional settings, such as schools, correctional facilities and the home. Delivery of services to young people through TMH requires several adjustments to practice with adults regarding the model of care, cultural values, participating adults, rapport-building, pharmacotherapy and psychotherapy. Additional infrastructure accommodations at the patient site include space and staffing to conduct developmentally appropriate evaluations and treatment planning with parents, other providers, and community services. For TMH to optimally impact young people's access to mental health care, collaborative models of care are needed to support PCPs as frontline mental health-care providers, thereby effectively expanding the child and adolescent mental health workforce.
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Affiliation(s)
- Nicole E Gloff
- a Division of Child and Adolescent Psychiatry , University of Maryland School of Medicine , Baltimore , Maryland
| | - Sean R LeNoue
- b Denver Health Medical Center , Colorado.,c Children's Hospital Colorado , University of Colorado Hospital, University of Colorado School of Medicine , Aurora , Colorado.,d Department of Psychiatry , University of Colorado School of Medicine
| | - Douglas K Novins
- d Department of Psychiatry , University of Colorado School of Medicine.,e Division of Child and Adolescent Psychiatry , University of Colorado School of Medicine.,f American Indian and Alaska Native Health , Colorado School of Public Health , Aurora , Colorado
| | - Kathleen Myers
- g School of Medicine , University of Washington.,h Telemental Health Service, Seattle Children's Services , Seattle , Washington , USA
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Alicata D, Schroepfer A, Unten T, Agoha R, Helm S, Fukuda M, Ulrich D, Michels S. Telemental Health Training, Team Building, and Workforce Development in Cultural Context: The Hawaii Experience. J Child Adolesc Psychopharmacol 2016; 26:260-5. [PMID: 26466015 DOI: 10.1089/cap.2015.0036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The goal of the University of Hawaii (UH) child and adolescent psychiatry telemental health (TMH) program is to train child and adolescent psychiatry fellows to provide behavioral health services for the children of Hawaii and the Pacific Islands in the cultural context of their rural communities using interactive videoteleconferencing (IVTC). The training experience balances learning objectives with community service. Learning objectives include: Understanding mental health disparities in rural communities, leveraging community resources in ongoing treatment, providing culturally effective care, and improving health care access and delivery through TMH service research and evaluation. METHODS We describe the UH experience. Several UH faculty are experienced with IVTC technology. They are triple-board trained, are recognized for their research in program evaluation and mental health disparities, and are committed to serving Hawaii's rural communities. We demonstrate the role of TMH in linking children and their families living in rural communities with multiple mental health treatment providers. The service-learning curriculum and a unique collaboration with Mayo Clinic provide the opportunity to examine the role of TMH in global service, and training, education, and research. RESULTS TMH provides direct services to patients and consultation on Hawaii Island and Maui County. The collaboration with the Mayo Clinic brings further consultation in complex diagnostics, pharmacogenomics, and cross-cultural psychiatry. A curriculum provides trainees experience with IVTC with the goal of potential recruitment to underserved rural communities. The TMH program at UH is unique in its team building and workforce development by joining multiple entities through IVTC and translating expertise from the Mayo Clinic to rural communities, and strengthening collaboration with local child and adolescent psychiatrists, and primary care and other mental health providers. CONCLUSIONS The UH psychiatry program is a model program to develop an expert mental health workforce in cultural context for children living in rural communities.
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Affiliation(s)
- Daniel Alicata
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Amanda Schroepfer
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Tim Unten
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Ruby Agoha
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Susana Helm
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Michael Fukuda
- 1 Department of Psychiatry, University of Hawaii-Manoa , John A. Burns School of Medicine, Honolulu, Hawaii
| | - Daniel Ulrich
- 2 State of Hawaii, Department of Health, Child and Adolescent Mental Health Division , Honolulu, Hawaii
| | - Stanton Michels
- 2 State of Hawaii, Department of Health, Child and Adolescent Mental Health Division , Honolulu, Hawaii
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Hilty DM, Shoemaker EZ, Myers K, Snowdy CE, Yellowlees PM, Yager J. Need for and Steps Toward a Clinical Guideline for the Telemental Healthcare of Children and Adolescents. J Child Adolesc Psychopharmacol 2016; 26:283-95. [PMID: 26871510 DOI: 10.1089/cap.2015.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This article identifies and describes key considerations toward the development of a clinical guideline intended to optimize telemental healthcare (TMH) of children and adolescents. METHODS The literature was searched with key terms and title words. Of 2824 articles that met primary or secondary key word search criteria, 326 met both criteria, and 118 thematically related directly to child and adolescent TMH. Only 44 studies met levels of evidence I-III and expert recommendation criteria used in clinical guidelines; review of their references found 8 additional studies (52 total). Data from adult, child, and adolescent in-person psychiatric care and adult TMH were applied to provide context in developing the key considerations. RESULTS TMH guidelines for adults are well delineated, and TMH guidelines for children and adolescents are likely to closely overlap in terms of general clinical, technical, and administrative issues. However, for a child and adolescent focus, modifications of existing general guidelines appear necessary; for example, based on developmental status, family involvement, and patient-site modifications for space and sound. Additional clinical issues include specify who, exactly, is the "patient" (i.e., the patient, family, and /or other stakeholders), modalities of care (i.e., age-related psychotherapies such as play therapy or behavior management), and psychopharmacology. CONCLUSIONS Specific clinical, administrative, and technical issues are key considerations - based on the nuances of established child and adolescent mental healthcare - and must be considered in developing a clinical guideline for TMH of these patients. Developing such guidance should proceed from a careful review of the growing evidence base, and through expert consensus processes.
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Affiliation(s)
- Donald M Hilty
- 1 Kaweah Delta Medical Center, Visalia, California.,2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Erica Z Shoemaker
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California.,3 Child and Adolescent Services Los Angeles County and University of Southern California Medical Center , Los Angeles, California
| | - Kathleen Myers
- 4 Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, Washington.,5 Telemental Health Service, Seattle Children's Hospital , Seattle, Washington
| | - Christopher E Snowdy
- 2 Department of Psychiatry and Keck School of Medicine at the University of Southern California , Los Angeles, California
| | - Peter M Yellowlees
- 6 Department of Psychiatry, UC Davis School of Medicine , Davis, California
| | - Joel Yager
- 7 Department of Psychiatry, University of Colorado at Denver School of Medicine , Denver, Colorado
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Kramer GM, Luxton DD. Telemental Health for Children and Adolescents: An Overview of Legal, Regulatory, and Risk Management Issues. J Child Adolesc Psychopharmacol 2016; 26:198-203. [PMID: 26259027 DOI: 10.1089/cap.2015.0018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The use of technology to provide telemental healthcare continues to increase; however, little has been written about the legal and regulatory issues involved in providing this form of care to children and adolescents. METHODS This article reviews existing laws and regulations to summarize the risk management issues relevant to providing telemental healthcare to children and adolescents. RESULTS There are several legal and regulatory areas in which telemental health clinicians need to have awareness. These areas include: 1) Licensure, 2) malpractice liability, 3) credentialing and privileging, 4) informed consent, 5) security and privacy, and 6) emergency management. CONCLUSIONS Although legal and regulatory challenges remain in providing telemental healthcare to children and adolescents, it is possible to overcome these challenges with knowledge of the issues and appropriate risk management strategies. We provide general knowledge of these key legal and regulatory issues, along with some risk management recommendations.
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Affiliation(s)
- Gregory M Kramer
- 1 National Center for Telehealth and Technology (T2) , Joint Base Lewis-McChord, Tacoma, Washington
| | - David D Luxton
- 1 National Center for Telehealth and Technology (T2) , Joint Base Lewis-McChord, Tacoma, Washington.,2 University of Washington School of Medicine , Seattle, Washington
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