How to Get Started in Telemental Health · 2016. 10. 19. · 1 Training in telemental health One time and annually updated CEs 2 Abide by association, credentialing body ethics One

© 2016 Behavioral Health Innovation, Jay Ostrowski © 2016 Behavioral Health Innovation, Jay Ostrowski

Jay Ostrowski, MA, LPC-S, NCC, DCC, ACS, CTCPCEO, Behavioral Health Innovation

Telemental Health Provider

How to Get Started in Telemental Health


Learning Objectives

1. Identify three best practices telemental health2. Know the minimum requirements for starting a

telemental health program3. Learn the key identifiers of HIPAA-secure

technology4. Know common pitfalls of a new telemental health

program

Overview


Disclosures & Disclaimers

• Affiliated with several organizations. • Behavioral Health Innovation• Adaptive Telehealth• Center for Credentialing & Education• Mid-Atlantic Telehealth Resource Center• telementalhealthcomparisons.com

• Not representing any organization.• Not a lawyer.

Overview

http://telementalhealthcomparisons.com


How to Get Started In Telemental Health

Industry OverviewService Design & Creation

Best Practices Choosing Technology

Minimum Requirements to StartCommon Pitfalls

IndustryOverview

Design & BestPractices

Start Up

Pitfalls

OverviewHow to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


Mental Health Service

Shortages

How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


Current Mental Health System

•Too costly•Ineffective •High relapse rates•Difficult to access•Not customer friendly•Most clients do not return for a second visit

~ Is rather depressing



Limited Access to Care

We will not have enough Mental Health Providers for the foreseeable future.



Meta-analysis of 148 peer-reviewed studies on the use of video therapy online

Meta-analysis of 92 studies of online therapyJournal of Technology in Human services, Vol. 26, No. 2 Clinical Psychology: Science and Practice, Vol. 16, No. 3

Positive Outcomes

High Patient Satisfaction

Moderate to High Clinical Satisfaction

In-Person TMH

EffectivenessResearch on Telemental Health

Overview How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


What does the research say about telemental health?Telemental Health Research

Same Efficacy Same MethodsLiterature supports efficacy of nearly all TMH/TBH services1

TMH uses same theoretical methods & techniques2

All in-person mental health services can be delivered via video3

Same ServicesNo

Contra-indications

Same Patients



How to Get Started

Service Design & CreationBest PracticesChoosing TechnologyMinimum Requirements to StartCommon Pitfalls

DesignHow to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski

How to Start?

© 2016 Behavioral Health Innovation, Jay Ostrowski Design


Find a Mentor

“Everyone’s gotta plan ‘till they get punched in the face.”

~ Mike Tyson

© 2016 Behavioral Health Innovation, Jay Ostrowski Design


What services are missing? What are the Market needs?Incremental adoption?

Access to care, access to specialtiesIncrease efficienciesReduce costsProvider retentionExpand market reach

Service Design & Creation

© 2016 Behavioral Health Innovation, Jay Ostrowski

Additional Considerations

Design How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski

• Client Home • Clinic-to-Clinic • Residential

Telemental Health Settings

• Schools • Corporations • Prisons


1. Text and email2. cCBT -Computerized Cognitive Behavioral Health Therapy3. mHealth - Apps4. Community forums - provider led, community led5. Video - individual, group - provider led6. Virtual Reality Exposure Therapy (VRET)

•Client led self-help•Provider led•Community led•Provider prescribed•Combinations

Types of Engagements



1 3

cCBT

Video

Text Based

Offer A Spectrum of Solutions

Design How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


Drug and Alcohol TreatmentRelapse Prevention

www.yourwebsiteurl.com

Your Text

Your Text

Your Text

Video Group Treatment & Aftercare


Introduction to Telemental Health © 2016 Behavioral Health Innovation

Clinic-to-clinic

Clinic-to-X School/Prisons/CorpClinic to client home (DTC = Direct-to-Consumer)

Clinician home to client home (DTC = Direct-to-Consumer)


Settings



AAMFT - American Association of Marriage and Family Therapists- Code of Ethics

ACA - American Counseling Association- Code of Ethics

AMA - American Medical Association- Resolution 317 in favor of quality telemedicine policies

APA - American Psychological Association- Guidelines for Ethical Practice of Telepsychology

ATA - American Telemedicine Association - Guidelines for Video Telemental Health

NASW - Standards for Technology and Social Work Practice

NBCC - National Board for Certified Counselors- Code of Ethics for Distance Services

Professional Guidelines

© 2016 Behavioral Health Innovation, Jay Ostrowski Best Practices


1 Training in telemental health2 Abide by ethics3 Data Security4 Display provider credentials5 TMH-specific informed consent6 Privacy protection7 Alternate communication8 Abide by Jurisdiction laws


9 Assess client suitability to venue10 Verify psychological safety 11 Verify the clients location at time of services12 Verify the client identity13 Verify the client’s age14 Identify emergency services local to client15 Emergency contact - person near client16 Provide viable referrals

Best Practices in TMH

Best Practices How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski

Core Concept Type of Activity Implementation

1 Training in telemental health One time and annually updated CEs

2 Abide by association, credentialing body ethics One time - set up protocol

3 Data Security - ensure data protected at login, in route and at rest Each session

4 Display provider verifiable credentials Info given At all times on promotional spaces

5 TMH-specific informed consent Info given 1st session

6 Privacy protection - informed consent Info given Each session

7 Provide alternate communication means and methods between sessions Info given 1st session

8 Jurisdiction - verify location/jurisdiction of client and provider Screening Each session - Location

9 Assess client suitability to venue Screening 1st session and throughout treatment

10 Verify psychological safety - no one else in client’s room & private space Screening Each session

11 Verify the clients location at the time of services in order to establish jurisdiction and emergency services Screening Each session

12 Verify the client identity Form 1st session

13 Verify the client’s age Form 1st session

14 Identify access to emergency services local to that client Form 1st session, each time different location

15 Emergency contact - person to contact near client in case of emergency Form 1st session

16 Provide viable referrals Last session


Best Practices in TMH

Best Practices How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


Consider• Security• Workflows• Scheduling• “Paperwork”• Referrals• Supervision• Mobility• Growth


1 3

Best Practices: Technology

TechHow to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


True of False?

No Technology is HIPAA Compliant.



Examples of technology made for Telehealth

https://www.telementalhealthcomparisons.com

adaptivetelehealth.com

securevideo.com

wecounsel.com


HIPAA-Secure Technology


https://www.telementalhealthcomparisons.com

http://adaptivetelehealth.com

http://securevideo.com

http://wecounsel.com


Key Factors•Setting where services take pace•Interface with existing technology?•Additional equipment required•Workflows that enable services•Budget

Choosing Technology (Part 1)



Technical Requirements•HIPAA compliance or security•Interoperable - EHRs & other TMH Apps•Multi-modal - Video, text, cCBT •Mobile enabled•Internet bandwidth requirements•Technical support needed

Choosing Technology (Part 2)



HIPAA-Secure Technology

HIPAA

Vendors should be able to tell you: • What ePHI is accessible to their staff • How they protect ePHI • Describe Administrative, • technical and physical controls



• Identify limited scope• Financial plan• Policies and procedures• Workflows• Time budget• Leadership & staff buy-in• HIPPA-secure software• Trained providers• Outcome measurement

Start

Minimum Start-Up Requirements

This is a generalization. Please ensure compliance with organizational, professional and state law, ethics and guidelines.How to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski


• HIPAA Secure Communication• Compliance workflows• Referral Workflows• On-boarding Clients• Scheduling• Clinical Documentation• Billing• Evaluation• Supervision

Workflows

StartHow to Get Started In Telemental Health © 2016 Behavioral Health Innovation. Jay Ostrowski

• Analysis paralysis • Poor/no systems • Too frugal • Too expensive • Too much change at once • Try to please everyone

© 2016 Behavioral Health Innovation, Jay Ostrowski Pitfalls

Common Pitfalls


Telehealth Resource Centers

http://www.telehealthresourcecenter.org/



http://www.telehealthresourcecenter.org/


Jay [email protected]

Thank you!

Thanks!

mailto:[email protected]?subject=


1. Godleski, L., Nieves, J. E., Darkins, A., & Lehmann, L. (2008). VA telemental health: Suicide assessment. Behavioral Science and the Law. doi:10.1002/bsl.811• O'Reilly, R., Bishop, J., Maddox, K., Hutchinson, L., Fisman, M., Takhar, J. (2007). Is Telepsychiatry Equivalent to Face-to-Face Psychiatry? Results from a

Randomized Controlled Equivalence Trial. Psychiatric Services, 58(6):836-43.• Ruskin, P.E., Silver-Aylaian, M., Kling, M.A., Reed, S.A., Bradham, D.D., Hebel, J.R., Barrett, D, Knowles, F. 3rd, Hauser, P. (2004). Treatment Outcomes in

Depression: Comparison of Remote Treatment through Telepsychiatry to In-Person Treatment. The American journal of Psychiatry, 161(8):1471-6. • Sharp, I.R., Kobak, K.A., Osman, D.A. (2011). Annals of General Psychiatry. The Use of Videoconferencing with Patients with Psychosis: A Review of the

Literature. 10(1):14.• Bouchard, S., Paquin, B., Payeur, R., Allard, M., Rivard, V., Fournier, T., et al. (2004). Delivering Cognitive-Behavior Therapy for Panic Disorder with

Agoraphobia in Videoconference. Telemed J E Health, 10(1):13-25.

2. De Las Cuevas C, Arredondo M, Cabrera M, Sulzenbacher M, Meise U. (2006) Randomized clinical trial of telepsychiatry through videoconference versus face-to-face conventional psychiatric treatment. Telemedicine Journal and e-Health.

3. American Telemedicine Association (2013). Practice guidelines for video-based online mental health services. Clinical Guidelines, 8, F-7, 11, 16–18. 5 • De Las Cuevas C, Arredondo M, Cabrera M, Sulzenbacher M, Meise U. (2006) Randomized clinical trial of telepsychiatry through videoconference versus face-

to-face conventional psychiatric treatment. Telemedicine Journal and e-Health. 12:341-350

4. Myers, K. & Turvey, C. (Eds.) (2013). Telemental health: Clinical, technical, and administrative foundations for evidence-based practice. Waltham, MA: Elsevier. 56.• Bishop J, O’Reilly R, Maddox K, Hutchinson L. (2002). Client satisfaction in a feasibility study comparing face-to-face interviews with telepsychiatry. Journal of

Telemedicine and Telecare. 8:217-221.

Same Efficacy Same Methods Same Services Same Patients

Telemental Health Research References


Documents

How to Get Started in Telemental Health · 2016. 10. 19. · 1 Training in telemental health One time and annually updated CEs 2 Abide by association, credentialing body ethics One