1
|
Goodman ZS, Gardner SM, Rustad JK, Finn CT, Landsman HS, Ho PA. Using Academic Consultation-Liaison Telepsychiatry to Meet the Mental Health Needs of Complex, Medically Ill Patients in Underserved Areas: A Case Report. Telemed J E Health 2024; 30:895-898. [PMID: 37917927 DOI: 10.1089/tmj.2023.0352] [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: 11/04/2023] Open
Abstract
Background: The nationwide shortage of mental health resources often disproportionately affects rural areas. As innovative strategies are required to address mental health resource shortages in rural areas, telepsychiatry consultation (TPC) may represent a population health-oriented approach to bridge this gap. In this case report, we examine the use of TPC from an academic consultation-liaison psychiatry service to a rural community hospital. Case Report: We describe the case of a woman with Wernicke encephalopathy seeking to leave the hospital against medical advice and the role that the TPC service played in the patient's evaluation and management, including assessing decision-making capacity. Discussion: We then examine benefits and limitations of the service, including a narrative review of the relevant, but limited, available literature as well as suggestions for how the service may be improved and incorporated into psychiatry residency and fellowship training in the future.
Collapse
Affiliation(s)
- Zachary S Goodman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Spencer M Gardner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - James K Rustad
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
- Department of Mental Health and Behavioral Sciences, White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Christine T Finn
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - H Samuel Landsman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Patrick A Ho
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| |
Collapse
|
2
|
Higgins WJ, Fisher WW, Hoppe AL, Velasquez L. Evaluation of a Telehealth Training Package to Remotely Teach Caregivers to Conduct Discrete-Trial Instruction. Behav Modif 2023; 47:380-401. [PMID: 36523128 DOI: 10.1177/01454455221138062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The present study evaluated the effectiveness of using telehealth technologies to remotely train caregivers of children with ASD to conduct discrete-trial instruction (DTI). We used a multiple-baseline-across-participants design to evaluate caregiver correct implementation of the DTI procedures and child emission of independent correct tacts as dependent measures. We observed robust and immediate improvements for all three caregivers and two of three children. Treatment effects were maintained during follow-up and generalization probes. We discuss the benefits of telehealth technologies and other remote treatment applications.
Collapse
Affiliation(s)
- William J Higgins
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Wayne W Fisher
- Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA.,Rutgers Robert Wood Johnson University Hostpital, Children's Specialized Hospital, New Brunswick, NJ, USA
| | - Amanda Logan Hoppe
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| | - Leny Velasquez
- University of Nebraska Medical Center's Munroe-Meyer Institute, Omaha, USA
| |
Collapse
|
3
|
The use and impact of digital technologies for and on the mental health and wellbeing of Indigenous people: A systematic review of empirical studies. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2021.106988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
4
|
Barnett P, Goulding L, Casetta C, Jordan H, Sheridan-Rains L, Steare T, Williams J, Wood L, Gaughran F, Johnson S. Implementation of Telemental Health Services Before COVID-19: Rapid Umbrella Review of Systematic Reviews. J Med Internet Res 2021; 23:e26492. [PMID: 34061758 PMCID: PMC8335619 DOI: 10.2196/26492] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/30/2021] [Accepted: 04/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Telemental health care has been rapidly adopted for maintaining services during the COVID-19 pandemic, and a substantial interest is now being devoted in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw on both COVID-19 experiences and the substantial research evidence accumulated before this pandemic. OBJECTIVE We aim to conduct an umbrella review of systematic reviews available on the literature and evidence-based guidance on telemental health, including both qualitative and quantitative literature. METHODS Three databases were searched between January 2010 and August 2020 for systematic reviews meeting the predefined criteria. The retrieved reviews were independently screened, and those meeting the inclusion criteria were synthesized and assessed for risk of bias. Narrative synthesis was used to report these findings. RESULTS In total, 19 systematic reviews met the inclusion criteria. A total of 15 reviews examined clinical effectiveness, 8 reported on the aspects of telemental health implementation, 10 reported on acceptability to service users and clinicians, 2 reported on cost-effectiveness, and 1 reported on guidance. Most reviews were assessed to be of low quality. The findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short term. Evidence on the extent of digital exclusion and how it can be overcome and that on some significant contexts, such as children and young people's services and inpatient settings, was found to be lacking. CONCLUSIONS This umbrella review suggests that telemental health has the potential to be an effective and acceptable form of service delivery. However, we found limited evidence on the impact of its large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for the future implementation of telemental health.
Collapse
Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Division of Psychology and Language Sciences, University College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Lucy Goulding
- King's Improvement Science, Centre for Implementation Science, King's College London, London, United Kingdom
| | - Cecilia Casetta
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom
| | - Harriet Jordan
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Luke Sheridan-Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Julie Williams
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Lisa Wood
- Division of Psychiatry, University College London, London, United Kingdom
| | - Fiona Gaughran
- NIHR Applied Research Collaboration, King's College London, London, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and Maudsley NHS Trust, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom.,Camden and Islington NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
Naslund JA, Mitchell LM, Joshi U, Nagda D, Lu C. Economic evaluation and costs of telepsychiatry programmes: A systematic review. J Telemed Telecare 2020; 28:311-330. [PMID: 32746762 DOI: 10.1177/1357633x20938919] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Telepsychiatry involves use of telecommunications technology to deliver psychiatric care and offers promise to reduce costs and increase access to mental health services. This systematic review examined cost reporting of telepsychiatry programmes for mental healthcare. METHODS We systematically searched electronic databases for studies reporting costs, including economic evaluations such as cost-effectiveness analyses, or costs of developing telepsychiatry programmes for clinical care of mental disorders. Included studies enrolled participants with mental disorders and involved telepsychiatry for depression, anxiety disorders, serious mental illnesses including schizophrenia spectrum disorders and bipolar disorder, post-traumatic stress disorder, dementia or epilepsy. RESULTS Twenty-six unique studies met inclusion criteria (17,967 participants), with most targeting depression (n = 7; 27%), general mental disorders and screening (n = 7; 27%), child mental health (n = 4; 15%) and geriatric mental health (n = 4; 15%). Nearly all studies (n = 25; 96%) compared telepsychiatry programme costs with either standard in-person consultation or usual care, with 15 (60%) reporting that telepsychiatry programmes were less expensive, and 8 (32%) showing telepsychiatry programmes were more expensive. Three studies reported cost-effectiveness analyses, favouring telepsychiatry programmes, but at highly elevated cost-effectiveness thresholds. Few studies reported costs of developing or delivering telepsychiatry programmes. CONCLUSION Costs of telepsychiatry programmes varied widely, with substantial heterogeneity in how costs were defined and reported. Some programmes cost less than in-person services while others cost more. Therefore, rigorous cost-effectiveness studies following established standards in economic evaluation are needed to inform implementation and sustainability of these programmes in health systems.
Collapse
Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | | | | | | | - Chunling Lu
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
6
|
Hensel J, Graham R, Isaak C, Ahmed N, Sareen J, Bolton J. A Novel Emergency Telepsychiatry Program in a Canadian Urban Setting: Identifying and Addressing Perceived Barriers for Successful Implementation: Un nouveau programme de télépsychiatrie d'urgence en milieu urbain canadien: Identifier et aborder les obstacles perçus d'une mise en œuvre réussie. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:559-567. [PMID: 31969011 PMCID: PMC7492888 DOI: 10.1177/0706743719900465] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To report on the perceived barriers surrounding the use of telepsychiatry for emergency assessments and our approach to overcoming those barriers to achieve successful implementation of a program to increase access to emergency psychiatric assessment in a Canadian urban setting. METHODS We conducted a survey of emergency care staff to inform the implementation of an emergency telepsychiatry program in the urban setting of Winnipeg, Manitoba, where hospitals have variable on-site emergency psychiatric coverage. We analyzed survey responses for perceived barriers we would need to address in implementation. We employed implementation strategies for each barrier and scaled the program to three sites over the first year. Data from the first year were collected including number of telepsychiatry assessments, reasons for referral, wait time, and percentage of patient transfers avoided. RESULTS Survey respondents (N = 111) had little prior exposure to telepsychiatry, but the majority were open to its use for emergency psychiatric assessments in the region. We identified three categories of perceived barriers: clinical, logistical/technical, and readiness barriers. Implementation planning addressed each barrier, and a hub-and-spoke program was launched. After the first year, the program had one hub serving three spokes, and 243 emergency telepsychiatry assessments had been completed. After 12 months, we were avoiding 65% of patient transfers. CONCLUSIONS By conducting a user survey to identify perceived barriers, and addressing these during implementation, we successfully scaled our emergency telepsychiatry program across our region. Our report of this experience may benefit others attempting to implement a similar program.
Collapse
Affiliation(s)
- Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Reid Graham
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Naweed Ahmed
- Department of Family Practice, University of British Columbia, Victoria, British Columbia, Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
7
|
Spivak S, Spivak A, Cullen B, Meuchel J, Johnston D, Chernow R, Green C, Mojtabai R. Telepsychiatry Use in U.S. Mental Health Facilities, 2010-2017. Psychiatr Serv 2020; 71:121-127. [PMID: 31615370 DOI: 10.1176/appi.ps.201900261] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the use of telepsychiatry in U.S. mental health facilities between 2010 and 2017. METHODS Changes over time in the availability of telepsychiatry were examined by using multiple waves of a national survey of mental health facilities. State and facility correlates of offering telepsychiatry in 2017 were examined. RESULTS The proportion of state facilities that self-reported offering telepsychiatry increased significantly from 15.2% in 2010 to 29.2% in 2017, with wide variability among states.. In 2017, facilities with telepsychiatry were more commonly publicly owned than to have others forms of ownership (odds ratio [OR]=2.72, 95% confidence interval [CI]=2.47-2.99, p<0.001), although the percentage of privately owned facilities offering telepsychiatry has increased significantly since 2010 (OR=2.94, 95% CI=2.14-4.05, p<.001). Facilities offering telepsychiatry had lower odds of receiving funding from Medicaid (OR=0.86, 95% CI=0.75-0.98, p<0.001) but higher odds of receiving funding from all other sources. Facilities in states that did not fund telepsychiatry had lower odds of offering these services in 2017 (OR=0.57, 95% CI=0.51-0.62, p<0.001). Telepsychiatry was more commonly offered in states with higher proportions of rural population (OR=1.64, 95% CI=1.45-1.85, p<0.001) and designated medically underserved areas (OR=1.36, 95% CI=1.25-1.47, p<0.001), compared with other states. CONCLUSIONS Nearly twice as many U.S. mental health facilities offered telepsychiatry in 2017 than in 2010. Medicaid funding lagged behind other funding sources, suggesting state administrative barriers. Telepsychiatry was commonly used by facilities in medically underserved and rural areas.
Collapse
Affiliation(s)
- Stanislav Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Amethyst Spivak
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Jennifer Meuchel
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Deirdre Johnston
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Rachel Chernow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Charee Green
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| | - Ramin Mojtabai
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (S. Spivak, Cullen, Meuchel, Johnston, Mojtabai); National Trafficking Shelter Alliance, Baltimore (A. Spivak); Department of Mental Health, Johns Hopkins University School of Public Health, Baltimore (Cullen, Mojtabai); Johns Hopkins Health Systems, Baltimore (Chernow, Green)
| |
Collapse
|
8
|
Jong M, Mendez I, Jong R. Enhancing access to care in northern rural communities via telehealth. Int J Circumpolar Health 2020; 78:1554174. [PMID: 31066652 PMCID: PMC6508052 DOI: 10.1080/22423982.2018.1554174] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The cost of providing health care in northern Canada is higher than the rest of Canada. Telehealth has the potential to reduce health care expenditures. Yet this is still underutilised in Canada and globally. This paper describes the services provided through telehealth in some northern regions of Canada. It provides recommendations on the requirements for setting up real presence telehealth and how utilisation can be enhanced. Telehealth offers potential benefits for health outcomes by increasing access to healthcare, and reducing expenditures.
Collapse
Affiliation(s)
- Michael Jong
- a Department of Family Medicine , Memorial University of Newfoundland , Happy Valley-Goose Bay , NL , Canada
| | - Ivar Mendez
- b Saskatoon Health Region , University of Saskatchewan , Saskatoon , Canada.,c Department of Surgery , Royal University Hospital , Saskatoon , SK , Canada
| | - Robert Jong
- d Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Caver KA, Shearer EM, Burks DJ, Perry K, De Paul NF, McGinn MM, Felker BL. Telemental health training in the Veterans Administration Puget Sound Health Care System. J Clin Psychol 2019; 76:1108-1124. [PMID: 31115049 DOI: 10.1002/jclp.22797] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/13/2018] [Accepted: 02/15/2019] [Indexed: 12/14/2022]
Abstract
As a pioneer of training in the field of psychology, the Veterans Affairs (VA) HealthCare System serves as a leader in the training in and provision of Telemental Health (TMH) services in the United States. To meet goals toward continued expansion of these services, the VA TMH training program includes both web-based didactic courses and a skills competency test at a basic level with supervision and consultation in TMH for more advanced training and is available to staff psychologists and psychologist trainees. Despite these efforts, barriers for training in and implementation of TMH occur at the provider, system, and patient level. At the national level, the VA is actively working to resolve these barriers and we share site-specific examples implemented by the VA Puget Sound Health Care System promoting access through TMH team to further address barriers to training and implementation.
Collapse
Affiliation(s)
- Kelly A Caver
- VA Puget Sound Health Care System, Seattle, Washington
| | | | - Derek J Burks
- VA Portland Health Care System, Portland, Oregon.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Kristen Perry
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | | | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Bradford L Felker
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| |
Collapse
|
11
|
Pollock NJ, Healey GK, Jong M, Valcour JE, Mulay S. Tracking progress in suicide prevention in Indigenous communities: a challenge for public health surveillance in Canada. BMC Public Health 2018; 18:1320. [PMID: 30482175 PMCID: PMC6260704 DOI: 10.1186/s12889-018-6224-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023] Open
Abstract
Indigenous peoples in Canada experience disproportionate rates of suicide compared to non-Indigenous populations. Indigenous communities and organizations have designed local and regional approaches to prevention, and the federal government has developed a national suicide prevention framework. However, public health systems continue to face challenges in monitoring the population burden of suicide and suicidal behaviour. National health data systems lack Indigenous identifiers, do not capture data from some regions, and do not routinely engage Indigenous communities in data governance. These challenges hamper efforts to detect changes in population-level outcomes and assess the impact of suicide prevention activities. Consequently, this limits the ability to achieve public health prevention goals and reduce suicide rates and rate inequities. This paper provides a critical analysis of the challenges related to suicide surveillance in Canada and assesses the strengths and limitations of existing data infrastructure for monitoring outcomes in Indigenous communities. To better understand these challenges, we discuss the policy context for suicide surveillance and examine the survey and administrative data sources that are commonly used in public health surveillance. We then review recent data on the epidemiology of suicide and suicidal behaviour among Indigenous populations, and identify challenges related to national surveillance. To enhance capacity for suicide surveillance, we propose strategies to better track progress in Indigenous suicide prevention. Specifically, we recommend establishing an independent community and scientific governing council, integrating Indigenous identifiers into population health datasets, increasing geographic coverage, improving suicide data quality, comprehensiveness, and timeliness, and developing a platform for making suicide data accessible to all stakeholders. Overall, the strategies we propose can build on the strengths of the existing national suicide surveillance system by adopting a collaborative and inclusive governance model that recognizes the stake Indigenous communities have in suicide prevention.
Collapse
Affiliation(s)
- Nathaniel J Pollock
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada. .,Labrador Institute of Memorial University, P.O. Box 490, Stn. B, 219 Hamilton River Road, Happy Valley-Goose Bay, Newfoundland and Labrador, A0P 1E0, Canada.
| | - Gwen K Healey
- Qaujigiartiit Health Research Centre, PO Box 11372, 764 Fred Coman Dr., Iqaluit, NT, X0A 0H0, Canada.,Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michael Jong
- Labrador-Grenfell Regional Health Authority, Labrador Health Centre, Happy Valley-Goose Bay, Newfoundland and Labrador, Canada.,Northern Family Medicine Program (NorFam), Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - James E Valcour
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Shree Mulay
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, Prince Philip Drive, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| |
Collapse
|
12
|
Lavoie JG, Ward A, Wong ST, Ibrahim N, Morton D, O’Neil JD, Green M. Hospitalization for mental health related ambulatory care sensitive conditions: what are the trends for First Nations in British Columbia? Int J Equity Health 2018; 17:156. [PMID: 30285775 PMCID: PMC6171151 DOI: 10.1186/s12939-018-0860-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 09/10/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Indigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living both on and off reserve in British Columbia, Canada, and explore the relationship between local access to health services and mental health-related hospitalization rates. METHODS A population-based time trend analysis of mental health-related Ambulatory Care Sensitive Conditions hospitalizations was conducted using de-identified administrative health data. The study population included all residents eligible under the universal British Columbia Medical Services Plan and living on and off First Nations reserves between 1994/95 and 2009/10. The definition of mental health-related Ambulatory Care Sensitive Conditions included mood disorders and schizophrenia, and three different change measures were used to operationalize avoidable hospitalizations: 1) rates of episodes of hospital care, 2) rates of length of stay, and 3) readmission rates. Data were analyzed using generalized estimating equations approach, controlling for age, sex, and socio-economic status, to account for change over time. RESULTS Our findings show that First Nations living on reserve have higher hospitalization rates for mental disorders compared to other British Columbia residents up until 2008. Those living off reserve had significantly higher hospitalization rates throughout the study period. On-reserve communities served by nursing stations had the lowest rates of hospitalization whereas communities with limited local services had the highest rates. Compared to other British Columbia residents, all First Nations have a shorter length of stay and lower readmission rates. CONCLUSIONS This study suggests that despite reduced rates of hospitalization for mental-health related Ambulatory Care Sensitive Conditions over time for First Nations, gaps in mental health care still exist. We argue greater investments in primary mental health care are needed to support First Nations health. However, these efforts should place equal importance on prevention and the social determinants of health.
Collapse
Affiliation(s)
- Josée G. Lavoie
- Department of Community Health Sciences, Ongomiizwin Research, University of Manitoba, Winnipeg, Canada
| | - Amanda Ward
- First Nations Health Authority, Vancouver, BC Canada
| | - Sabrina T. Wong
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Naser Ibrahim
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Darrien Morton
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - John D. O’Neil
- Faculty of Health sciences, Simon Fraser University, Burnaby, Canada
| | - Michael Green
- Departments of Family Medicine and Community Health and Epidemiology, Queen’s University, Kingston, Canada
| |
Collapse
|
13
|
Tarlow KR, Johnson TA, McCord CE. Rural Status, Suicide Ideation, and Telemental Health: Risk Assessment in a Clinical Sample. J Rural Health 2018; 35:247-252. [DOI: 10.1111/jrh.12310] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Kevin R. Tarlow
- School of Public HealthTexas A&M University College Station Texas
| | - Tina A. Johnson
- School of Public HealthTexas A&M University College Station Texas
| | - Carly E. McCord
- School of Public HealthTexas A&M University College Station Texas
| |
Collapse
|
14
|
Mahmoud H, Vogt E. Telepsychiatry: an Innovative Approach to Addressing the Opioid Crisis. J Behav Health Serv Res 2018; 46:680-685. [DOI: 10.1007/s11414-018-9611-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
15
|
Bustamante Madsen L, Eddleston M, Schultz Hansen K, Konradsen F. Quality Assessment of Economic Evaluations of Suicide and Self-Harm Interventions. CRISIS 2018; 39:82-95. [DOI: 10.1027/0227-5910/a000476] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Abstract. Background: Death following self-harm constitutes a major global public health challenge and there is an urgent need for governments to implement cost-effective, national suicide prevention strategies. Aim: To conduct a systematic review and quality appraisal of the economic evaluations of interventions aimed at preventing suicidal behavior. Method: A systematic literature search was performed in several literature databases to identify relevant articles published from 2003 to 2016. Drummond's 10-item appraisal tool was used to assess the methodological quality of the included studies. Results: In total, 25 documents encompassing 30 economic evaluations were included in the review. Of the identified evaluations, 10 studies were found to be of poor quality, 14 were of average quality, and six studies were considered of good quality. The majority of evaluations found the interventions to be cost-effective. Limitations: Several limitations were identified and discussed in the article. Conclusion: A notable few economic evaluations were identified. The studies were diverse, primarily set in high-income countries, and often based on modeling, emphasizing the need for more primary research into the topic. The discussion of suicide and self-harm prevention should be as nuanced as possible, including health economics along with cultural, social, and political aspects.
Collapse
Affiliation(s)
- Lizell Bustamante Madsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Eddleston
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Pharmacology, Toxicology & Therapeutics, University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kristian Schultz Hansen
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
16
|
Naskar S, Victor R, Das H, Nath K. Telepsychiatry in India - Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs. Indian J Psychol Med 2017; 39:223-242. [PMID: 28615754 PMCID: PMC5461830 DOI: 10.4103/0253-7176.207329] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.
Collapse
Affiliation(s)
- Subrata Naskar
- Department of Neuropsychiatry, Institute of Neurosciences, Kolkata, West Bengal, India
| | - Robin Victor
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Himabrata Das
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| | - Kamal Nath
- Department of Psychiatry, Silchar Medical College and Hospital, Silchar, Assam, India
| |
Collapse
|
17
|
Hubley S, Lynch SB, Schneck C, Thomas M, Shore J. Review of key telepsychiatry outcomes. World J Psychiatry 2016; 6:269-82. [PMID: 27354970 PMCID: PMC4919267 DOI: 10.5498/wjp.v6.i2.269] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 01/27/2016] [Accepted: 03/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To conduct a review of the telepsychiatry literature. METHODS We conducted a systematic search of the literature on telepsychiatry using the search terms, "telepsychiatry", "telemental health", "telecare", "telemedicine", "e-health", and "videoconferencing". To meet criteria for inclusion, studies had to: (1) be published in a peer-reviewed journal after the year 2000; (2) be written in English; (3) use videoconferencing technology for the provision of mental health assessment or treatment services; and (4) use an adequately-powered randomized controlled trial design in the case of treatment outcome studies. Out of 1976 studies identified by searches in PubMed (Medline database), Ovid medline, PsychInfo, Embase, and EBSCO PSYCH, 452 met inclusion criteria. Studies that met all inclusion criteria were organized into one of six categories: (1) satisfaction; (2) reliability; (3) treatment outcomes; (4) implementation outcomes; (5) cost effectiveness; and (6) and legal issues. All disagreements were resolved by reassessing study characteristics and discussion. RESULTS Overall, patients and providers are generally satisfied with telepsychiatry services. Providers, however, tend to express more concerns about the potentially adverse of effects of telepsychiatry on therapeutic rapport. Patients are less likely to endorse such concerns about impaired rapport with their provider. Although few studies appropriately employ non-inferiority designs, the evidence taken together suggests that telepsychiatry is comparable to face-to-face services in terms of reliability of clinical assessments and treatment outcomes. When non-inferiority designs were appropriately used, telepsychiatry performed as well as, if not better than face-to-face delivery of mental health services. Studies using both rudimentary and more sophisticated methods for evaluating cost-effectiveness indicate that telepsychiatry is not more expensive than face-to-face delivery of mental health services and that telepsychiatry is actually more cost-effective in the majority of studies reviewed. Notwithstanding legal concerns about loss of confidentiality and limited capacity to respond to psychiatric emergencies, we uncovered no published reports of these adverse events in the use of telepsychiatry. CONCLUSION A large evidence base supports telepsychiatry as a delivery method for mental health services. Future studies will inform optimal approaches to implementing and sustaining telepsychiatry services.
Collapse
|
18
|
Abstract
Telepsychiatry is increasingly being used in many parts of the world. We performed a systematic review of the literature on the use of telepsychiatry in acute treatment settings using MEDLINE, EMBASE, and PsycINFO from inception to June 2013 using the following key words: acute telepsychiatry, teleconsultation, teleconferencing, telemedicine, emergency telepsychiatry, and e-mental health. Only articles in English were included. All study abstracts were reviewed by both authors independently to assess whether the topic of the paper was relevant to the review. References were selected independently until no new papers were found. If there was a disagreement, a discussion between the authors took place. A leading expert in this field was contacted to check for gray literature. The review included 23 papers. No meta-analyses or systematic reviews were found. The main results are (1) that patients have a positive attitude toward the technology and show a high level of satisfaction with telepsychiatry, (2) that the use of telepsychiatry is correlated with decreased admissions to psychiatric inpatient units, (3) that the quality of clinical interaction in telepsychiatry is similar to that in face-to-face care, and (4) that telepsychiatry seems to be cost effective. The use of telepsychiatry seems to be a viable and relatively inexpensive option for use in places where access to emergency services is difficult.
Collapse
|
19
|
Crosby Budinger M, Cwik MF, Riddle MA. Awareness, attitudes, and use of crisis hotlines among youth at-risk for suicide. Suicide Life Threat Behav 2015; 45:192-8. [PMID: 25093445 DOI: 10.1111/sltb.12112] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 05/30/2014] [Indexed: 01/18/2023]
Abstract
Crisis hotlines have been central to suicide prevention efforts; however, utilization among youth remains low. A sample of at-risk youth was surveyed about their awareness, utilization, and attitudes toward local and national crisis hotlines. Youth reported low rates of awareness and utilization, yet expressed a strong interest in phone hotlines (41% vs. 59% for new media categories combined). Youth reported stigma, but that help-seeking could be positively influenced by peers and adults in their support system. Implications include making crisis services available across several mediums and the importance of engaging trusted others in youth suicide awareness campaigns and prevention efforts.
Collapse
|
20
|
Zaheer J, Links PS, Law S, Shera W, Hodges B, Tsang AKT, Huang X, Liu P. Developing a Matrix Model of Rural Suicide Prevention. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2014. [DOI: 10.2753/imh0020-7411400403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Paul S. Links
- b University of Western Ontario, London, Ontario, Canada
| | - Samuel Law
- a University of Toronto, Toronto, Ontario, Canada
| | - Wes Shera
- a University of Toronto, Toronto, Ontario, Canada
| | - Brian Hodges
- a University of Toronto, Toronto, Ontario, Canada
| | | | | | - Pozi Liu
- d Department of Psychiatry, Yuquan Hospital, Tsinghua University, Beijing, China
| |
Collapse
|
21
|
Hilty DM, Ferrer DC, Parish MB, Johnston B, Callahan EJ, Yellowlees PM. The effectiveness of telemental health: a 2013 review. Telemed J E Health 2014; 19:444-54. [PMID: 23697504 DOI: 10.1089/tmj.2013.0075] [Citation(s) in RCA: 543] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION The effectiveness of any new technology is typically measured in order to determine whether it successfully achieves equal or superior objectives over what is currently offered. Research in telemental health-in this article mainly referring to telepsychiatry and psychological services-has advanced rapidly since 2003, and a new effectiveness review is needed. MATERIALS AND METHODS The authors reviewed the published literature to synthesize information on what is and what is not effective related to telemental health. Terms for the search included, but were not limited to, telepsychiatry, effectiveness, mental health, e-health, videoconferencing, telemedicine, cost, access, and international. RESULTS Telemental health is effective for diagnosis and assessment across many populations (adult, child, geriatric, and ethnic) and for disorders in many settings (emergency, home health) and appears to be comparable to in-person care. In addition, this review has identified new models of care (i.e., collaborative care, asynchronous, mobile) with equally positive outcomes. CONCLUSIONS Telemental health is effective and increases access to care. Future directions suggest the need for more research on service models, specific disorders, the issues relevant to culture and language, and cost.
Collapse
Affiliation(s)
- Donald M Hilty
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, California 95817, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Seidel RW, Kilgus MD. Agreement between telepsychiatry assessment and face-to-face assessment for Emergency Department psychiatry patients. J Telemed Telecare 2014; 20:59-62. [PMID: 24414395 DOI: 10.1177/1357633x13519902] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We compared psychiatrists' evaluations of Emergency Department (ED) mental health patients made face-to-face or by telemedicine. In a 39-month study, 73 patients presenting in the ED were enrolled after initial screening. Patients were interviewed by a psychiatrist either face-to-face in the ED or remotely by video. A second psychiatrist, acting as an observer, was in the room with the patient and independently completed the assessment. Based on the primary diagnosis of the interviewer, 48% of patients had a depressive disorder, 18% a substance use disorder, 14% a bipolar disorder, 11% a psychotic disorder, 6% an anxiety disorder and 4% other disorders. The raw agreement between the psychiatrists about disposition when both used face-to-face assessment was 84% and it was 86% when one used telemedicine. Using Cohen's kappa to evaluate agreement, there were no significant differences for disposition recommendation, strength of recommendation, diagnosis or the HCR-20 dangerousness scale. There was no significant difference for the intraclass correlation coefficients for the suicide scale. The results provide preliminary support for the safe use of telepsychiatry in the ED to determine the need for admission to inpatient care.
Collapse
Affiliation(s)
- Richard W Seidel
- Carilion Clinic, Virginia Tech, Carilion School of Medicine, Roanoke, Virginia, USA
| | | |
Collapse
|
23
|
Stubbings DR, Rees CS, Roberts LD, Kane RT. Comparing in-person to videoconference-based cognitive behavioral therapy for mood and anxiety disorders: randomized controlled trial. J Med Internet Res 2013; 15:e258. [PMID: 24252663 PMCID: PMC3842436 DOI: 10.2196/jmir.2564] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 07/23/2013] [Accepted: 10/15/2013] [Indexed: 12/16/2022] Open
Abstract
Background Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. Methods A total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction. Results Retention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81), and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62). Conclusions The findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two. Trial Registration Australian New Zealand Clinical Trials Registry ID: ACTRN12609000819224; http://www.anzctr.org.au/ACTRN12609000819224.aspx (Archived by WebCite at http://www.webcitation.org/6Kz5iBMiV).
Collapse
Affiliation(s)
- Daniel R Stubbings
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University of Technology, Perth, Australia
| | | | | | | |
Collapse
|
24
|
Gros DF, Morland LA, Greene CJ, Acierno R, Strachan M, Egede LE, Tuerk PW, Myrick H, Frueh BC. Delivery of Evidence-Based Psychotherapy via Video Telehealth. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2013. [DOI: 10.1007/s10862-013-9363-4] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
25
|
Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Olden M, Cukor J, Rizzo AS, Rothbaum B, Difede J. House calls revisited: leveraging technology to overcome obstacles to veteran psychiatric care and improve treatment outcomes. Ann N Y Acad Sci 2010; 1208:133-41. [PMID: 20955335 PMCID: PMC4018828 DOI: 10.1111/j.1749-6632.2010.05756.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Despite an increasing number of military service members in need of mental health treatment following deployment to Iraq and Afghanistan, numerous psychological and practical barriers limit access to care. Perceived stigma about admitting psychological difficulties as well as frequent long distances to treatment facilities reduce many veterans' willingness and ability to receive care. Telemedicine and virtual human technologies offer a unique potential to expand services to those in greatest need. Telemedicine-based treatment has been used to address multiple psychiatric disorders, including posttraumatic stress disorder, depression, and substance use, as well as to provide suicide risk assessment and intervention. Clinician education and training has also been enhanced and expanded through the use of distance technologies, with trainees practicing clinical skills with virtual patients and supervisors connecting with clinicians via videoconferencing. The use of these innovative and creative vehicles offers a significant and as yet unfulfilled promise to expand delivery of high-quality psychological therapies, regardless of clinician and patient location.
Collapse
Affiliation(s)
- Megan Olden
- Department of Psychiatry, Weill Cornell Medical College of Cornell University, New York, New York 10065, USA.
| | | | | | | | | |
Collapse
|
27
|
Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
Collapse
Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
28
|
Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
Collapse
|
29
|
Rhodes A, Bethell J, Jaakkimainen RL, Thurlow J, Spence J, Links PS, Streiner DL. The impact of rural residence on medically serious medicinal self-poisonings. Gen Hosp Psychiatry 2008; 30:552-60. [PMID: 19061682 DOI: 10.1016/j.genhosppsych.2008.06.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/28/2008] [Accepted: 06/30/2008] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Suicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship. METHOD A cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time. RESULTS The rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males. CONCLUSIONS The rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.
Collapse
Affiliation(s)
- Anne Rhodes
- Suicide Studies Unit, St. Michael's Hospital, Toronto, ON, Canada M5B 1W8.
| | | | | | | | | | | | | |
Collapse
|
30
|
Krysinska KE, De Leo D. Telecommunication and suicide prevention: hopes and challenges for the new century. OMEGA-JOURNAL OF DEATH AND DYING 2008; 55:237-53. [PMID: 18214070 DOI: 10.2190/om.55.3.e] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Development of information technology has created new opportunities and challenges in suicide prevention, research, and clinical practice. This article presents an overview of the wide range of telecommunication-based suicide prevention approaches. Interventions using the Internet, telephone, and videoconferencing are discussed, including crisis intervention, referral, and support, suicide risk assessment, psychotherapy for individuals at risk, and online-based suicide prevention training and education. Research regarding effectiveness of telecommunication-based suicide prevention in various demographic and clinical populations is reviewed, as well as concerns regarding this type of intervention. Future areas of research and development in the use of telecommunication media in prevention of suicide are discussed.
Collapse
|
31
|
Godleski L, Nieves JE, Darkins A, Lehmann L. VA telemental health: suicide assessment. BEHAVIORAL SCIENCES & THE LAW 2008; 26:271-286. [PMID: 18548515 DOI: 10.1002/bsl.811] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The Department of Veterans Affairs (VA) encompasses one of the largest telemental health networks in the world, with over 45,000 videoconferencing and over 5,000 home telemental health encounters annually. Recently, the VA designated suicide prevention as a major priority, with telehealth modalities providing opportunities for remote interventions. Suicide risk assessments, using videoconferencing, are now documented in the literature, as are current studies that find telemental health to be equivalent to face-to-face treatment. Remote assessment of suicidality, however, involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability.
Collapse
Affiliation(s)
- Linda Godleski
- Yale School of Medicine, VA Connecticut Healthcare System, CT 06516, USA.
| | | | | | | |
Collapse
|
32
|
Hirsch JK. A review of the literature on rural suicide: risk and protective factors, incidence, and prevention. CRISIS 2007; 27:189-99. [PMID: 17219751 DOI: 10.1027/0227-5910.27.4.189] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide is a major cause of mortality worldwide. Differences in rates of suicide exist between urban and rural areas; however, little rigorous research has examined the phenomena of rural suicide. OBJECTIVE This review examines the current body of literature on rural suicide and investigates differences between rural and urban suicide, including socioeconomic, psychological, and cultural variables. Prevention and intervention strategies specific to rural communities are discussed. DESCRIPTION OF STUDIES: All empirical and epidemiological studies of rural suicide were included in the review regardless of study design or methodology. RESULTS Although findings are mixed, research and epidemiological data indicate that suicide is a public health concern in rural areas, with suicide rates often greater than in urban areas. DISCUSSION Rural locale may create geographic, psychological, and sociocultural barriers to treatment of suicide. A better understanding of the role of rurality in the development and maintenance of suicidal thoughts and behaviors is needed and may inform prevention and intervention efforts.
Collapse
Affiliation(s)
- Jameson K Hirsch
- Department of Psychology, Rochester Institute of Technology, Rochester, NY 14623, USA.
| |
Collapse
|
33
|
Winters JM, Winters JM. Videoconferencing and Telehealth Technologies Can Provide a Reliable Approach to Remote Assessment and Teaching Without Compromising Quality. J Cardiovasc Nurs 2007; 22:51-7. [PMID: 17224698 DOI: 10.1097/00005082-200701000-00008] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cardiovascular disease remains a significant chronic healthcare problem in this country, with considerable associated economic and quality-of-life challenges. Along with these challenges, there is high demand for healthcare provider time, particularly in the areas of management of complex healthcare needs and patient education. At the same time, a critical nursing shortage exists. Telehealth technologies provide opportunities to meet the rapidly growing needs of consumers and healthcare practitioners. Many in need of services have limited access to high-end technologies. An argument has been made that the lowest level of technology needed to carry out a task should be used, if it is capable of providing the necessary services. Videoconferencing capabilities allow healthcare practitioners to engage in virtual face-to-face encounters with patients or other healthcare providers. A variety of levels of sophistication in these videoconferencing systems are available. In an effort to evaluate the effectiveness and consumer satisfaction with videoconferencing, 3 pilot studies were conducted to compare face-to-face, low-bandwidth, and high-bandwidth approaches to performing common assessments and patient education activities. In one study, a variety of experienced healthcare practitioners performed functional assessments of stroke subjects using a collection of validated scales by varying approaches (face-to-face, low-bandwidth, and high-bandwidth videoconferencing) in a randomized order. In a second study, undergraduate nursing students performed similar performance measures and taught an unfamiliar individual how to program and use an intravenous pump device, take a tympanic temperature, or to draw up insulin in a syringe. In the third study, advanced practice nursing students assessed vital signs and performed cardiopulmonary assessments on community-dwelling subjects using low-bandwidth and face-to-face approaches. Healthcare practitioners and students generally preferred high-bandwidth approaches over low-bandwidth alternatives when videoconferencing was performed; however, most participants and practitioners were satisfied with the encounters, regardless of the level of technology used.
Collapse
Affiliation(s)
- Jill M Winters
- Office of Nursing Research and Scholarship, College of Nursing, Marquette University, PO Box 1881, Milwaukee, WI 53201-1881, USA.
| | | |
Collapse
|
34
|
Shore JH, Hilty DM, Yellowlees P. Emergency management guidelines for telepsychiatry. Gen Hosp Psychiatry 2007; 29:199-206. [PMID: 17484936 PMCID: PMC1986661 DOI: 10.1016/j.genhosppsych.2007.01.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/24/2007] [Accepted: 01/24/2007] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Telepsychiatry, in the form of live interactive videoconferencing, is an emerging application for emergency psychiatric assessment and treatment and can improve the quality and quantity of mental health services, particularly for rural, remote and isolated populations. Despite the potential of emergency telepsychiatry, the literature has been fairly limited in this area. METHOD Drawing on the combined clinical and administrative experiences of its authors, this article reviews the common administrative, legal/ethical and clinical issues that arise in emergency telepsychiatry. RESULTS An initial set of guidelines for emergency telepsychiatry is presented to generate further discussion to assist those who are considering establishing general telepsychiatry and/or emergency telepsychiatry services. CONCLUSION The practices and techniques of emergency telepsychiatry are relatively new and require further examination, modification and refinement so that they may be fully utilized within comprehensive mental health service systems.
Collapse
Affiliation(s)
- Jay H Shore
- American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Nighthorse Campbell Native Health Building, Aurora, CO 80045-0508, USA.
| | | | | |
Collapse
|