An Introduction to Telebehavioral Health

1. An Introduction to Telebehavioral Health Jodi Polaha, Ph.D., East Tennessee State University

2. Overview Presentation Style Dealing with Distance Example and Research Setting It Up

3. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Equipment Staff Scheduling

4. Provider Site: Teleconferencing Client site: Teleconferencing Setting It Up: Equipment

5. Setting It Up: Equipment Types: • POTS, e-mail, internet, etc. • Store-and-forward • Robotic telepathology • Home health devices • Real-time video/two-way videoconferencing

6. Setting It Up: Equipment Home Health

7. Monitor-Based PC-Based, “Web Cams” Setting It Up: Equipment Videoconferencing Polycom, LIfeSize, Tandberg Logitech, Via-Video, ViGO

8. Dedicated Line “T1” Faster/Clearer More stable More secure Internet “High-Speed”/Cable Cheaper Easier More flexible Setting It Up: Equipment Transmission:

9. Provider Site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Client site: Teleconferencing FAX/e-records Telephone access Good lighting Forms Toys/Specialized equipment Setting It Up: Equipment

10. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Equipment Staff Scheduling

11. Provider Site: IT person (on call) Coordinator Client Site: IT person (on call) Coordinator Setting It Up: Staff

12. Setting It Up: Staff Provider Site Coordinator: • Maintains list of all sites, connection info • Orients new sites • Provides central point of contact for all parties • Manages billing/insurance for provider • Manages other paper work

13. Setting It Up: Staff Client Site Coordinator: • Coordinates room/equipment in advance • Assists in insuring paperwork is administered • Tests client equipment, demonstrates, troubleshoots • *Insures professionalism, privacy at client site • Provides point of contact for all parties during the visit

14. Setting It Up: Staff Checklist

15. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Equipment Staff Scheduling

16. Setting It Up: Scheduling Patient/ Referral Source Clinician Site Coordinator Confirm Repeat Clinician Patient Site Coordinator Both “yes” Either “no”

17. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

18. Presentation Style: Camera Skills and Set Up • Sit > 8’ to improve “eye contact.” • Frame head and tops of shoulders. • Use PIP to insure your image. • Practice with the remote. • Be aware of “mute.” • If possible, keep your materials in front of you.

19. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

20. Presentation Style: Meeting the Client Checklist

21. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Camera Skills and Set Up Equipment Staff Meeting the Client Scheduling Theatrics

22. Presentation Style: Theatrics • Wear blue, or at least, no stripes. • Exaggerate nonverbal behavior. • Label your “off screen” behavior. • “Mute” your microphone when not talking.

23. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Building Rapport Camera Skills and Set Up Equipment Staff Cultural and Related Issues Meeting the Client Scheduling Theatrics

24. Dealing with the Distance: Building Rapport • Discuss concerns or skepticism at outset and throughout. • “Shape” interaction with equipment by reinforcing verbalizations, use of remote, response to delay, etc. • Consider having children or others who may be disruptive “skip” the first visit. • Vocalize/ask about what you can’t see/hear. • Reinforce patient responsiveness to atypical framework.

25. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Building Rapport Camera Skills and Set Up Equipment Staff Cultural and Related Issues Meeting the Client Scheduling Theatrics

26. Dealing with the Distance: Cultural and Related Issues The State of New Mexico is importing its mental health services for the prison system from Indiana. What problems might be encountered from a therapeutic perspective? Can these be overcome? If so, how? If not, why?

27. Dealing with the Distance: Cultural and Related Issues • Engage site visits at intervals. • Consider focusing on one geographic area. • Know as much as possible about client’s town/geographic area. • Acknowledge needs while working toward increased cultural competence. • Take action when clients are not responding well.

28. Overview Setting It Up Presentation Style Dealing with Distance Example and Research Building Rapport Camera Skills and Set Up Equipment Nebraska Program Staff Cultural and Related Issues Meeting the Client Other Research Scheduling Theatrics

29. MMI Behavioral Health Outreach Clinics2006 Nebraska Program Gordon BHC Est. 2004 at Gordon Medical Clinic Chadron BHC Est. 2004 at Chadron Medical Clinic Valley BHC Est. 2003 Fremont BHC Est. 2005 at Professional Partners Omaha-Metro Clinics Papillion BHC, 2000 Eagle Run BHC, 2001 Creighton BHC, 2003 Crawford BHC Est. 2004 at Crawford Medical Clinic Columbus BHC Est. 1997 at CCH Pediatric Kearney BHC Est. 2003 at Kearney Clinic Pediatrics Plattsmouth BHC Est. 2000 at UMA Plattsmouth Hastings BHC Est. 1998 at Children and Adolescent Clinic, P.C Nebraska City BHC Est. 2004 at Physicians Clinic Crete BHC Est. 2005 at Physician’s Clinic Lincoln BHC Est. 2005

30. Nebraska Program MMI Behavioral Health Outreach Program Mission 1. Provide Behavioral Health Services 2. Train and Retain Providers 3. Conduct research 4. Address public policy

31. Nebraska Program

32. Nebraska Program Adjunct Service: The Pediatric Behavioral Telehealth Clinic Aims • Provide temporary services as needed • Provide “permanent” services as needed • Provide value-added specialty services • Give consumers choice • Provide supervision for licensure

33. Nebraska Program Omaha Omaha

34. Nebraska Program: Services Provided • 13 remote sites • 90-420 miles from Omaha • 0-45 “consumer” miles (M=10)

35. Nebraska Program: Services Provided Omaha Omaha

36. Nebraska Program: Services Provided • 49 families in over 230 visits • regular outpatient visits (n=0-18, M=6)

37. Nebraska Program: Services Provided • Age: M = 8.2 yrs • Insurance: 45% Medicaid • Referral: 75% primary care physicians 20% specialty clinics 5% other

38. Nebraska Program: Services Provided Presenting Complaints: • Disruptive behavior (ODD/ADHD)25 • Behavior with MR 9 • Toileting 2 • Sleep 2 • Anxiety/Mood 5 • Hair Pulling 1 • Feeding Disorder 1

39. Nebraska Program: Outcomes 1=disagree; 6=agree

40. Nebraska Program: Outcomes

41. Nebraska Program: Discussion • Movement to more localized/regional model

42. Nebraska Program: Services Provided Omaha Omaha

43. Nebraska Program: Discussion • Movement to more localized/regional model • Increased rigor in outcome study • Improvements to satisfaction survey

44. Nebraska Program: Overview Setting It Up Presentation Style Dealing with Distance Example and Research Building Rapport Camera Skills and Set Up Equipment Nebraska Program Staff Cultural and Related Issues Meeting the Client Other Research Scheduling Theatrics

45. Nebraska Program: Other Research • Feasibility studies • Satisfaction surveys • Demonstration projects • Controlled trials