Originally posted on mHealth Intelligence
To Dr. Bruce Miewald, telemedicine licensure isn’t a means to acquire more patients and do more business. It’s an opportunity to reach out and help people in other parts of the country who need his expertise.
The Coeur D’Alene, Idaho-based physician who specializes in child psychiatry is poised to become one of the first in the country to complete the licensure process through the Interstate Medical Licensure Compact, which went live last year. Once completed, he’ll have the chance to work with health systems – and, more importantly, patients – in distant states where access to a psychiatrist is limited.
“I don’t need a business boost – I’m always very busy,” says Miewald, who’s been practicing for 27 years. “But there are places where I can be really useful.”
Miewald’s specialty is in strong demand all across the country. Between 1995 and 2013, the total number of adult and child psychiatrists in the US rose by 12 percent, to just under 50,000. Yet the number of physicians in the country rose by 45 percent during that time span, and the nation’s population increased by 37 percent, according to the Association of American Medical Colleges.
Meanwhile, according to the physician search firm Merritt Hawkins, close to 60 percent of the nation’s psychiatrists are 55 or older and about 48 percent are 60 or older and nearing retirement, making them the fourth-oldest group of doctors practicing among 41 medical specialties.
The need for psychiatrists in behavior care
At the same time, the need for psychiatrists is intensifying.
“As accountable care organizations and managed care organizations seek solutions that meet the Triple Aim of improving care, improving health outcomes and reducing cost, they will increasingly turn to psychiatrists for their help and guidance,” the National Council for Behavioral Health reported in a March 2017 study on the national psychiatric shortage. “The lack of an adequately trained workforce, however, poses a serious challenge in meeting this demand.”
“Since the passage of the Affordable Care Act, more Americans are now insured and are seeking treatment,” Dr. Atul Grover, executive vice president of the Association of American Medical Colleges, told Forbes Magazine in a June 2017 story. “Mental health parity laws have resulted in better behavioral health coverage than there was 20 years ago. In addition, demand is higher because there is greater awareness of, and willingness to talk about, mental health issues.”
Miewald, who’s affiliated with Kootenai Health-Coeur D’Alene, is part of Insight Telepsychiatry, a New Jersey-based national telepsychiatry provider. He’d held licenses in the past to practice in Montana and Pennsylvania, and has long used a video-based platform to facilitate his practice.
“I was it – the only child psychiatrist for that population in the five northern counties” of Idaho, he says. “I used to see people who would have to drive 90 miles one way, and driving through Idaho in winter can be kind of interesting. So [telemedicine] gave me a chance to make that easier.”
But there’s a real need for his services in Iowa and West Virginia, and he’s looking to complete the IMLC process to make himself available, through Insight’s network, to hospitals and clinics in those states.
“I’m not seeing that it’s going to be much different from what I’m doing here,” he says. “It’s just that I’d like to help out where I’m needed.”
Casey Papp, InSight’s Quality and Compliance Manager, helped Miewald with the process. They started by supplying background information and filling out attestation and eligibility forms from Miewald’s home state. Once approval was granted in Idaho, they selected additional states within the IMLC network to apply for accreditation.
“Every state is a little bit different in what they want,” says Papp. “You have to make sure you have everything lined up. It’s easier [than before the IMLC was enacted], but it could be even easier.”
Still, Miewald says the compact gives physicians like himself an opportunity to help where they’re most needed. Using a telemedicine platform, he can schedule in blocks of time to see patients in those other states, fitting that in around his own workflow.
“In my experience, I’d say 99 percent of the people think it works just as well” as an in-person visit, he says of the telemedicine platform. “And it saves a lot of time and travel. And with the kids, in some ways they seem to enjoy it more.”
MARLTON, NJ –InSight Telepsychiatry is recognizing the outstanding performance of its providers through its first Provider of the Year Award. Maaz Siddiqui, M.D., a scheduled services telepsychiatry provider, and Suraya Kawadry, M.D., an on-demand services telepsychiatry provider, are the 2018 recipients.
The InSight Provider of the Year Award is an annual award recognizing InSight providers who have displayed outstanding performance during the previous year. The providers are selected based on a number of performance factors, including quality of care, communication skills, flexibility, teamwork and alignment with InSight’s mission. Providers of the Year are celebrated for their exemplary work improving access to behavioral health services to underserved individuals and communities. Winners of the award exhibit excellent customer service to their peers, the staff at the partner sites they serve, the InSight administrative team and, most importantly, patients.
Spotlight on Dr. Siddiqui
The InSight Scheduled Services Provider of the Year Award goes to Dr. Maaz Siddiqui this year for his dedication to his patients and commitment to providing quality telepsychiatry services. Dr. Siddiqui is psychiatrist licensed in Minnesota, Michigan, Pennsylvania and New Jersey (where he resides), and serves primarily partners in outpatient mental health settings. He had an interest in psychiatry throughout medical school and he strongly believes in getting to know his patients, not just prescribing.
“It’s not just a checklist you have to go through,” said Dr. Siddiqui. “I want to know my patients, and I really do enjoy getting to know them.”
He has been with InSight for almost two years. On a typical day, he works 8-9 hours and sees 7-10 patients or more daily. The majority of his work is medication management.
“Dr. Siddiqui has a reputation for being very thorough and time-sensitive to patients’ needs, regardless of how many are on his schedule,” said John DiNicola, InSight’s lead program coordinator of scheduled services. “I can tell when speaking to him that he is passionate about what he does and gives patients the best quality of care—they’re not just a number to him.”
When establishing a provider-patient relationship, Dr. Siddiqui says creating trust from the very beginning is most important. “I’ve heard from other providers that rapport can be a problem, but it isn’t for me,” he said “I let patients know that it might be difficult at first, but I want to establish that trust and rapport from the very beginning, putting their anxiety at ease.”
Dr. Siddiqui is also known for his excellent communication with InSight’s operations team. “He is always quick to inform our operations team of matters that need our attention,” said DiNicola. “He has been a great InSight citizen.”
Spotlight on Dr. Kawadry
The InSight On-Demand Services Provider of the Year Award goes to Suraya Kawadry this year for her hard work and positivity as she increases access to psychiatric care to those in need across the country. Dr. Kawadry is a child and adolescent psychiatrist who lives in Missouri. In the true spirit of telepsychiatry, Dr. Kawadry is licensed not only in Missouri but also Colorado, Delaware, Florida, Iowa, Illinois, New Jersey, Montana, Michigan, North Carolina, Pennsylvania, South Carolina, Virginia and Washington. After a per-diem role with InSight during her fellowship, she transitioned to a full-time role working as a crisis telepsychiatrist serving hospitals in the many states where she is licensed.
Dr. Kawadry is regularly complimented for being a pleasure to work with, responsive in her communication, positive and flexible. Dr. Kawadry is always the first telepsychiatry provider to help out her peers by covering shifts when needed. “The InSight team often hears positive comments from its partners about her,” said April Isik, InSight’s program coordinator of on-demand services.
After she completed her medical school rotations, Dr. Kawadry decided to enter the field of psychiatry since it was the only rotation that she enjoyed and that intrigued her. As an on-demand telepsychiatry provider, Dr. Kawadry now immerses herself in the busy life of a crisis psychiatrist from the comfort of her home. She typically sees 8-13 patients per day in the emergency department or medical floor setting where she does psychiatric assessments and helps to determine the least restrictive and most appropriate level of care for each patient. She also conducts phone consultations with hospital staff to make recommendations regarding orders or disposition.
Dr. Kawadry is well-liked at all of the sites where she works. “She is extremely flexible, responsive and always goes the extra mile,” said InSight scheduler Nicole Prince. “She is great to work with and an even greater person!”
When it comes to clinical care, Dr. Kawadry believes that being a “chameleon” is the most important thing for establishing a provider-partner relationship. “With this line of work, we encounter so many different types of patients in so many different settings,” said Dr. Kawadry. “I think that it is important to always stay true to yourself as a person and as a physician, but at the same time tailor your interview and your demeanor based on the specific patient and setting that is at hand.”
With this honor comes a prize towards attending a professional development conference with InSight and additional public recognition.
“The whole experience of working for InSight has been just wonderful thus far, and I am very grateful,” said Dr. Kawadry. “Receiving this award was certainly a very humbling and rewarding experience.”
Originally published on OPEN MINDS
GETTYSBURG, Pa. (January 21, 2018) — OPEN MINDS announced InSight Telepsychiatry (InSight) as the newest bronze-level partner of The OPEN MINDS Circle–the award-winning online information and education platform with a user-base of over 150,000 health and human service executives. As part of the partnership, InSight, a national leader in the telehealth space, will collaborate with OPEN MINDS to provide telepsychiatry-focused thought leadership throughout 2018 – including an executive web briefing (webinar) and multiple free resources.
“We are excited about our new partnership with OPEN MINDS,” said InSight, CEO, Geoffrey Boyce. “We’ve looked to OPEN MINDS for great industry information for years and look forward to contributing our own expertise to the organization and its members through this partnership.”
Building a solid telebehavioral health strategy
InSight will also be releasing a new white paper on how to build a solid telebehavioral health strategy in conjunction with June’s 2018 OPEN MINDS Strategy & Innovation Institute in New Orleans. The free resource will be available online through The OPEN MINDS Circle platform, as well as at the InSight Telepsychiatry exhibit booth in the institute exhibit hall.
“I’m pleased that we will be expanding our work with the InSight team in 2018. Our last technology survey showed that in the past year, telehealth adoption has almost doubled among provider organizations serving complex consumers. And, InSight’s thought leadership in the telehealth space is needed now more than ever,” said OPEN MINDS Chief Executive Officer, Monica E. Oss. “Through this partnership package, we’re able to join forces with the experts at InSight for the first time. We look forward to collaborating and bringing high-value telehealth content to OPEN MINDS Circle readers in 2018.”
Containing over 500,000 articles, reports, presentations, data sets, how-to tools, and resources from OPEN MINDS and our partner organizations, The OPEN MINDS Circle has grown into the largest information platform in the behavioral health and human service industry. Membership provides access to daily curated email newsletters and the full online information library platform. Learn more or sign-up free at https://www.openminds.com/membership/.
About InSight + Regroup
InSight + Regroup (now Array Behavioral Care) is the leading and largest telepsychiatry service provider in the US with a mission to transform access to quality behavioral health care. InSight + Regroup serves hundreds of organizations and individuals in various settings across the continuum of care with its on-demand, scheduled services and direct-to-consumer (Inpathy) divisions. Given its size, diversity of services and extensive experience and expertise, InSight + Regroup is uniquely positioned to enable scalable telepsychiatry programs across the care continuum. As an industry thought leader, InSight + Regroup has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.
About OPEN MINDS
OPEN MINDS is an award-winning information source, executive education provider, and business solutions firm specializing in the behavioral health and human service field. For thirty years, we’ve been pioneers for change – helping organizations implement the transformational business practices they need to succeed in an evolving market with new policies and regulations.
OPEN MINDS is powered by a national team of experienced executives and subject matter experts with specific expertise and experience in markets of the health and human service field serving complex consumers. Our mission is to improve the quality of care for individuals with complex support needs by improving the effectiveness of those serving them – provider organizations, payer and insurance organizations, government agencies, pharmaceutical organizations, and technology firms. Learn more at www.openminds.com
By: Barry Doan
Original article published on Benefits Pro
The value of an employer’s health benefit strategy is intrinsically linked to its ability to address an employee’s total health—both physical and mental. That’s why overall wellness trends are shifting to better acknowledge the strong connection between a robust behavioral health care benefit and better overall health, ultimately resulting in improved employee productivity.
While many wellness programs today incorporate tactics that promote positive behavioral lifestyle changes, they often fall short of systematically addressing behavioral health conditions that can hinder an employee’s willingness and ability to embrace those needed changes. Altering entrenched behavioral health lifestyle patterns can be difficult, even if it’s a change that would be beneficial for the member. For instance, diabetic employees are much less likely to engage in diet and exercise programs when they are struggling with active depression that robs them of energy, focus and motivation. These members often represent a substantial percentage of those with chronic health conditions who make up a disproportional share of total healthcare expenditures.
This reality is why many companies are setting their sights on comprehensive employee “well-being” as opposed to “wellness” alone. By prioritizing access to both physical and behavioral health care, employers set the stage for more systemic and long-lasting engagement in self-care—and ultimately improve employee well-being, productivity and the bottom line. It’s important to note, however, that while many companies have invested heavily in identifying high-risk, high-cost employees and programs to engage these employees, access to care is still a major obstacle to this change process.
Telemedicine Options into Health Benefit Packages
As part of this shift, many employers are incorporating telemedicine options into health benefit packages as a viable solution for addressing access issues related to traditional in-office care. Telepsychiatry is emerging as a growing opportunity within this movement as an effective means of overcoming common barriers to behavioral health utilization such as stigma, busy lifestyles and poor coordination of services. These models help attract busy and reluctant employees who might otherwise procrastinate getting the help they need.
As a clinical model that leverages videoconferencing technology, telepsychiatry and telebehavioral health are used for evaluations, consultations and ongoing treatment. Employees access this care through live, interactive communication with a licensed psychiatry or behavioral health provider in a private setting. This improved access allows employees to not only address their behavioral health concerns before issues become more acute and costly, but also to reduce the behavioral health impairment that interferes with their ability and desire to engage in employer wellness programs.
The behavioral health challenge
The statistics speak for themselves. Behavioral health issues were the leading cause of disability in 2015, accounting for one-third of new claims.
Depression, for instance, ranks high as an employer health challenge, racking up an estimated $210.5 billion per year — nearly half of which is attributed to workplace absenteeism and productivity losses. In fact, one study points to employer costs as high as $3,386 per individual over a two-year period prior to an employee’s depression diagnosis.
Behavioral health issues often impact the effectiveness of wellness programs directed at physical conditions due to existing co-morbidities. One study found that 45 percent of breast cancer patients also had a psychiatric disorder.
While these statistics may be startling, the good news is that companies can achieve notable return on investment in wellness and complex condition management programs by investing in mental health treatment. In one study, researchers found that for every dollar spent treating depression, $1.55 was spent on the effects of depression in the workplace.
Quantifying the Impact of Behavioral Health Treatment
It’s not always easy to quantify the impact of behavioral health treatment, but human resource managers overwhelmingly agree that a healthy, well balanced employee is a better teammate and more productive worker. Often, the problem is getting employees to utilize the behavioral health benefits that are already available to them.
Consider a common example: A company launches an active lifestyle program that includes tracking daily physical activity as one means of supporting the employee’s goals of improving her health. A single mom in the workforce, who already struggles with mild depression and anxiety, finds it difficult to rise to the challenge of addressing her wellness goals. Feelings of guilt and inadequacy over this “failure” exacerbate her behavioral health conditions, ultimately decreasing her physical activity and lowering her overall health scores. Unfortunately, the wellness coach does not recognize the behavioral health condition that is impairing participation and fails to make an appropriate referral for additional professional support. The employee becomes demoralized, feels even worse and drops out of the program, and an opportunity is lost.
Even when the employee recognizes the underlying behavioral health condition that is compromising her health and happiness, she may have challenges taking the desired action to address it. While an existing behavioral health benefit would cover the employee’s treatment, she still must do the following research:
Taking hold of the telepsychiatry opportunity
Offering telepsychiatry and other behavioral health care services as part of employee benefits is a trend on the rise, and for good reason
When employees can access psychiatrists and therapists from the comfort of their home or another private space, the behavioral health stigmas are reduced, and individuals are more apt to follow through with care plans. Privacy and confidentiality are also stronger with telepsychiatry because online sessions eliminate the potential of individuals seeing someone they know in a waiting room. Many patients also report greater comfort addressing difficult issues while in familiar surroundings.
Additionally, telepsychiatry expands scheduling options and provider choice, opening the door to greater access. Work and family schedules, for instance, can limit the ability of employees to access traditional services provided in an office setting. Through telepsychiatry, employees can schedule appointments in evenings or on weekends in addition to traditional weekday time slots, which reduces absenteeism or tardiness from work.
The reality is that patient satisfaction trends are higher with online psychotherapy as opposed to traditional face-to-face treatment. While telepsychiatry and telebehavioral health are not for every person, this approach to care addresses many of the common barriers to receiving prompt, professional behavioral health treatment that sets the stage for greater overall health and wellbeing.
Employers seeking to achieve the greatest return on health plan investment are wise to consider telepsychiatry and telebehavioral health as means for promoting use of behavioral health benefits. This effective model of care provides the needed framework for improving access to appropriate healthcare resources and empowering employees to take more control of their health.
By: Geoffrey Boyce
Originally published on Behavioral Healthcare Executive
In the world of telehealth, what a difference a few years can make. The industry has moved from burgeoning to mainstream and is seen as a viable model for behavioral healthcare. In fact, industry professional shortages are catapulting adoption and use of telepsychiatry to address unmet psychiatric needs in all states.
The field of telepsychiatry has much to celebrate in recent years, and the outlook ahead is brighter than ever. Here are five top predictions about where telepsychiatry is headed in 2018.
Consumerism is taking healthcare by storm as individuals demand greater access, convenience and empowerment in their care choices. It’s why the American Telemedicine Association recently named uptake of consumer-driven technology as one of the top five trends for the telemedicine market in 2018.
Thus, it’s understandable why the “anywhere, anytime” access of telepsychiatry continues to drive growth of direct-to-consumer models. As individuals embrace the ability to access care at home or other comfortable locations where a reliable Internet connection exists, continued evolution of this trend is expected.
Consumers will increasingly recognize the advantages of heightened availability that enables scheduling of sessions outside of traditional office hours. Many increasingly find that video-conferencing models tear down communication barriers and reduce stigma—a key factor that otherwise keeps many from seeking behavioral health treatment. Additionally, individuals can look outside of local referral networks to access services, expanding provider options and consumer choice.
Perhaps there is no greater confirmation of telemedicine’s positive impact on care delivery than recent policy and legislation developments. The clear majority of states have enacted or proposed some form of parity regarding insurance coverage of telemedicine.
This activity will likely continue as demand for greater access to behavioral health services soars and stakeholders recognize the benefits of telepsychiatry models.
Additionally, in efforts to address the growing opioid epidemic, President Donald Trump earlier this year declared a public health emergency, calling for expanded telehealth access for Americans in need of care. Telehealth is a valuable solution to help improve care and the overall outlook around this significant public health crisis. To ensure that the addiction and mental healthcare disciplines continue to advance and embrace telehealth, and in turn, increase access to much needed services surrounding this crisis, it will be important for states to closely monitor and enact legislation that considers all types of telehealth. For example, language written to curb the prescribing of schedule II drugs via telehealth might extend to the best-practice prescribing of medication for children with ADHD via telepsychiatry, causing unintended limitations.
The premise of value-based care is higher quality, better outcomes and lower costs. Industry stakeholders increasingly recognize that care delivery must address the whole health of individuals—both physical and behavioral—to achieve sustainable “value.” Individuals are best engaged in their care plans and overall wellness when behavioral health is addressed in tandem with physical illness.
As providers and employers embrace this reality, they are finding that telepsychiatry effectively addresses fragmentation that often exists across the behavioral health continuum. Timely access to behavioral health services—whether emergent or ongoing—improves continuity of care and mitigates the need for higher cost interventions. Especially in multifaceted cases with complex pharmacology, video consultations improve access to multi-disciplinary treatment teams and direct telepsychiatry interventions to improve monitoring and provide ongoing patient engagement.
In synch with positioning for value-based care, healthcare communities will continue to see growth of connected community models in 2018. This will be especially evident in progressive communities that recognize the need for a comprehensive, sustainable and multifaceted behavioral health strategy that increases access to care across the continuum.
For instance, communities will continue to realize notable gains in the coming year by integrating telepsychiatry across multiple settings including:
The industry is also witnessing significant uptake and use of telepsychiatry in areas outside of the healthcare setting as community organizations recognize the advantages. A few examples of new settings include:
Looking ahead, the opportunities for leveraging telepsychiatry in new settings are endless as communities creatively address behavioral health needs. The telemedicine industry has come a long way in just a few years, and great momentum exists going in to 2018.
Over the course of a decade, the use of online health care has evolved rapidly both in popularity and technologically. Today, there is a widespread acceptance for easy access to care across the continuum through telehealth, especially with the treatment of behavioral health. Telepsychiatry has given those that have limited access to behavioral health care a chance to seek care at their convenience from any location. Dena Ferrell is no stranger to this progression. Celebrating her 10-year anniversary with the CFG Health Network and InSight Telepsychiatry this year, she has witnessed the expansion of telehealth and telepsychiatry, as well as the increased access to behavioral health treatment.
At the outset of her freshman year of college, Ferrell stepped onto the campus of Rutgers University with dreams of conquering the corporate business world. She enrolled in all of the pre-requisite classes she would need to pursue a business degree, as well as one psychology course. Ferrell soon discovered business was not the right fit for her. She followed her gut and changed her major to what she knew she would enjoy more – psychology.
“I had some family members with mental illness and always wanted to help people in general, so it was a great fit,” said Ferrell.
Ferrell’s educational background provided the basis for what would result in a long career of service in the behavioral health field. As InSight’s operations director, Dena is an influential and respected leader across the organization.
Ferrell’s First Steps in Leadership and Impact in Behavioral Health
Ferrell’s first job out of Rutgers was at a partial care program in a community mental health center, where she worked with a small group of patients with severe and persistent mental illness in a vocational rehab setting. Ferrell continued her career in behavioral health at Newpoint Behavioral Health Care in 1995, where she spent 12 years as a New Jersey state Certified Mental Health Screener. She conducted evaluations of adults and children in emergency department (ED) psychiatric crises, consulted with psychiatrists and appropriate dispositions and provided 24 hour coverage on their suicide hotline. Newpoint was a partner of CFG and one of the first organizations to pilot telepsychiatry, so Ferrell was able to be an early telepsychiatry adopter during her work there.
“Telepsychiatry allowed me to establish a treatment plan for a crisis patient very quickly,” said Ferrell. “It was clear to me way back then that telepsychiatry was going to be a very important part in behavioral health moving forward. Telepsychiatry was not widely used back then and it is so nice to see other programs and services utilizing it now.”
Today, Ferrell still has close ties to the team at NewPoint, who have remained a valued InSight Telepsychiatry and CFG partner since those early days.
Following her stint at Newpoint, Ferrell began her career with the CFG Health Network as an intake coordinator and ED case manager for Virtua Behavioral Health. She coordinated patient referrals to Virtua’s behavioral health unit from crisis centers, medical hospitals and clinicians, gathered all pertinent clinical, medial and demographic information and presented each case to the psychiatrist.
Overtime, Ferrell took on the role of managing CFG’s call center, the Access Center. The Access Center at that time primarily served CFG’s clients, while a small part of the call volume was dedicated to InSight Telepsychiatry, CFG’s growing telemedicine arm. However, as time passed and InSight expanded, a growing amount of the Access Center’s work was dedicated to InSight. InSight grew from serving just a few partners in surrounding states to a national operation with hundreds of partners across 28 states. Today, the Access Center is the main hub for monitoring InSight’s on-demand 24/7 telepsychiatry services.
Taking the Leadership in Behavioral Health
In early 2017, the Access Center rolled-out a new telepsychiatry platform, AccessInSight. Partners generate requests via AccessInSight and cases are automatically assigned to the InSight telepsychiatry provider best suited for that interaction. AccessInSight improves efficiencies for telepsychiatry encounters and allows for advanced data tracking – certainly a big change from the Access Center’s early days!
“The technology for telepsychiatry and telehealth has improved so much since my start,” said Ferrell. “Years ago, we used large, cumbersome equipment that had to be plugged in to various outlets and at the time it was not the norm to talk to someone via video. Today the equipment is much more streamlined and a connection can be made by the click of a button. Since many people use video in their day to day communications, it is much more accepted now.”
She expects the use of telepsychiatry will continue to grow, especially the direct to consumer services.
“Lawmakers, regulators and insurance payers are now recognizing telehealth as a covered benefit that provides a much-needed service,” said Ferrell. “It seems everyone is recognizing there are better ways of doing things, and telehealth is one of them.”
Along with the growing use of telepsychiatry in the past 10 years, Ferrell has seen growth within InSight as well. She described how InSight has become much more sophisticated in recruiting, onboarding new providers and implementing new programs. The addition of staff over the past decade has been beneficial in keeping up with the volume of partner sites and providers joining the InSight team. InSight has also smartly stayed focused on partnering with like-minded organizations that share InSight’s vision of increasing access to care.
Most people fail to realize what goes on behind the scenes, and the passion that goes into the work and dedication of providing access to behavioral health care. Ferrell’s motivation lies in knowing that in every contract InSight serves for any service line, there is a patient and their family in need of help during a very difficult time of their lives. “I am so happy to be part of that service,” said Ferrell.
Ferrell envisions a bright future for telepsychiatry. She believes the stigma for mental illnesses will decrease, and more people will be open to receiving behavioral health care both in-person and online.
Where does Ferrell see herself in the next 10 years? “I’d love to say retired! I will still be in the mental health field in some capacity. I have a very good understanding of behavioral health needs and like using that experience to help the patients who need it most.”
By: James Varrell, M.D.
Originally published on Arizona Telemedicine Program
As a child and adolescent psychiatrist practicing in person for a number of years, and eventually making the shift to telepsychiatry, I have observed the subtle differences and nuances between the two mediums of care.
In my experience, telepsychiatry can be particularly powerful when working with children and teens. I had one experience with a 15-year-old adolescent who was admitted to the hospital for the fourth time with continued severe abdominal pain that could not be attributed to a medical cause. The hospital staff was puzzled, as the diagnostic tests did not show any signs of ailments and there were no physical afflictions present in the child. Interestingly enough, the teen had already been evaluated by another psychiatrist at the hospital, who was unable to get the teen to “open up.”
However, a caring on-site staff member had noted the teen admired technology. She recommended that the telemedicine cart that was normally used in the ED be brought up to the teen’s room to connect him to a telepsychiatrist who specializes in child and adolescent psychiatry. It was clear he felt much more at ease talking with me on a screen than he had been talking with his in-person providers. During our session, I was able to leverage his interest in technology, as well as my child and adolescent psychiatry experience, in order to ease his reservations about sharing his story. I found that in the past the teen had seen his brother shot in the stomach, causing psychological trauma that resulted in his abdominal pain.
Just as my experiences have shown, the effect of technology on children in a clinical setting has been researched and shown to have positive impacts in a number of ways. In one study, adolescents reported that telemedicine promoted a transfer of power and control by allowing them to feel more comfortable with terminating a consultation or walking out of it, that the process is more structured, and that the adolescents feel better informed when speaking with a telepsychiatry provider, which can result in a better understanding, sense of shared responsibility and better decision making.
Psychiatry & Telepsychiatry
Although telepsychiatry is almost identical to in-person psychiatry, there are small adaptations providers can make to facilitate responses, especially in the case of special populations, including children and adolescents. Provider flexibility is often the key to success. Slowing down your speech, communicating with gestures and remembering to not infantilize your speech when evaluating children can all contribute to establishing a more effective patient-provider relationship. I educate other telepsychiatrists about games they can play and questions they can ask to encourage children to interact with them more freely. It can also sometimes be beneficial to involve a child’s parents or an on-site facilitator in the session to observe interactions. These tactics have helped me gain trust and encourage meaningful responses from children I have treated through telepsychiatry.
In the case of the boy with stomach pain, instead of providing continued costly and time-consuming medical intervention, we were able to get him the appropriate psychiatric treatment after our conversation.
The best care, especially for children, adapts to the preferences and needs of each individual. Telemedicine is a fantastic tool for increasing specialty care options and making sure that every person can access the right provider and the right type of care for them.
Marlton, NJ – On December 5th, 2017 InSight Telepsychiatry hosted a webinar titled “What NJ’s Telemedicine Policy Means for Behavioral Health.” The webinar recording can be accessed here.
After viewing the webinar, participants will:
InSight Telepsychiatry Hosts Webinar on the Implications of the Recently Passed New Jersey Telemedicine Legislation
The webinar was presented by Geoffrey Boyce, the Executive Director of InSight Telepsychiatry and an advocate for the appropriate use and value of telebehavioral health. Boyce discussed the new telehealth law and how it differs from previous regulation and also reviewed the key aspects of the bill and how they will affect the behavioral health industry and organizations that partner with behavioral health organizations.
Finally, Boyce looked at how the law can be used to expand access to psychiatry, mental and behavioral health care across the care continuum. Attendees will learn how they can use this bill to be active participants in changing the behavioral health industry.
“We’re enthused by the opportunities for improved access to care that this new law brings to the telemedicine industry and to New Jersey,” says Geoffrey Boyce, Executive Director of InSight Telepsychiatry. “We’re happy to share these updates with stakeholders in the field so they can be applied at their respective organizations.”
Over the summer, New Jersey passed the telehealth legislation making it one of the most innovative and supportive telemedicine states in the country. The state is already home to a handful of telemedicine programs, and the new law provides the opportunity for the continued expansion of telemedicine.
About InSight + Regroup
InSight + Regroup (now Array Behavioral Care) is the leading and largest telepsychiatry service provider in the US with a mission to transform access to quality behavioral health care. InSight + Regroup serves hundreds of organizations and individuals in various settings across the continuum of care with its on-demand, scheduled services and direct-to-consumer (Inpathy) divisions. Given its size, diversity of services and extensive experience and expertise, InSight + Regroup is uniquely positioned to enable scalable telepsychiatry programs across the care continuum. As an industry thought leader, InSight + Regroup has helped shape the field, define the standard of care and advocate for improved telepsychiatry-friendly regulations. To learn more, visit www.arraybc.com.
By: Jeanine Miles, LPC
Original article published on NAMI
Unprecedented need exists for child and adolescent mental health services in today’s communities, however, parents have limited options at their disposal. Shortages of child psychologists and psychiatrists are leaving our most vulnerable populations without care. Currently, all U.S. states are facing high or severe shortages, with many communities lacking even one qualified child and adolescent psychiatrist.
We need an effective solution, and it might be telebehavioral health. This convenient, accessible model of care has been gaining traction: Studies consistently reveal high satisfaction rates for children, adolescents and parents, often reaching above 90%. In fact, a 2013 study determined that telebehavioral health might be better than in-person care for children and adolescents because this age group often expresses an unwillingness or reluctance to participate in traditional therapy sessions.
Telebehavioral health might be a natural solution for improving access to care, but that’s just one benefit. As a counselor who offers telesessions, I’ve seen many more. Consider the following:
Comfortable Surroundings
Clinical office settings often intimidate children and adolescents. I find that younger populations are more willing to open up when they are in their own environment surrounded by familiar possessions or in reach of pets who may offer comfort. With telebehavioral health, I also get clues and information from a home environment I never see in an office setting.
For example, one child was well-behaved during our traditional office appointments. Yet her mother described a very different child with erratic behaviors while at home. Through our telebehavioral health sessions, I could see family interactions that confirmed the mother’s assessment. I was then able to teach the young girl and her family healthy coping techniques right there “at home.”
Familiar Modes Of Communication
Younger generations have grown up with technology. In fact, a 2015 study shows 67% of teens own a smartphone and spend more than four hours daily engaged with it. Videoconferencing, therefore, is a natural fit for today’s youth. Many teens prefer telesessions compared to traditional office sessions because it’s familiar and helps build trust. Simply put: Today’s youth are more comfortable communicating through a screen.
Easier Scheduling
One of the greatest barriers to engaging younger populations in mental health treatment is stigma. Many adolescents fear their peers will find out they go to therapy and ask questions. Professional shortages and scheduling challenges often causes students to miss school to attend therapy sessions. When a student leaves school early or checks in late, their peers may ask questions or make them feel uncomfortable.
With telebehavioral health, scheduling becomes much easier, as sessions can take place outside of traditional office hours. Patients do not have to miss school, nor do they run the risk of running into someone they know in a waiting room.
When choosing a telebehavioral health care organization or provider for your child, it’s important to do research before pursuing treatment. Things to consider are whether or not they are HIPAA-compliant, if they offer technical or care navigation support, whether they have providers licensed in your state, and if you can pay with your insurance plan. A good place to start is a reference guide, such as the one created by Open Minds that lists reputable telebehavioral health organizations.
Telebehavioral health care is changing the way communities and families approach mental health services. At a time when the need for mental health care is soaring, this option holds great promise for addressing gaps in care and providing parents with a critical resource for addressing their child’s health and well-being.
Jeanine Miles, LPC, Cognitive Behavioral Therapist with Inpathy and the Director of Business Development and Training at the Center for Family Guidance. Jeanine is a New Jersey Licensed Professional Counselor and has over 20 years of administrative and management experience in healthcare and behavioral healthcare. She is responsible for the development and implementation of new programs including overseeing all start-up projects, social skills training and school based programs. Jeanine has provided therapy and other telebehavioral health services through Inpathy since the program was launched and has long been an advocate for telebehavioral health.
Original article published on Becker’s Health IT & CIO Review
By: Mark Alter, M.D.
Today’s hospital emergency departments (EDs) are facing a perfect storm of behavioral health challenges. A combination of professional shortages and rapid growth in need for behavioral health services is creating significant supply and demand issues across U.S. communities. The overwhelming reality is that 42.5 million Americans struggle with mental health conditions, and professional shortages exist in all 50 U.S. states.
For many communities, the hospital ED has become one of the primary entry points for behavioral health access. Yet, few EDs are equipped with the expertise to handle the scope and complexities of this evolving challenge, leading to lengthy wait times and overcrowding, especially for patients in needs of psychiatric care.
To improve the outlook, hospitals are increasingly turning to the promise of on-demand telepsychiatry—an approach to care providing psychiatric evaluation or consult as needed via videoconferencing. These forward-looking care delivery models not only improve response times and access to services, but they also positively impact patient satisfaction and the bottom line.
The ED Behavioral Health Challenge: A Deeper Look
Current estimates suggest that one in eight ED visits involves a mental health condition, yet patients in need of evaluation often wait much longer than those in need of general medical care. One report found that 23 percent of psychiatric patients had emergency visits that were longer than six hours and 7 percent waited longer than 12 hours—that’s compared to 10 percent and 2.3 percent of other medical patients respectively. In addition, almost 21 percent of patients in need of an inpatient psychiatric bed wait between two and five days.
In terms of adequate staffing for psychiatric issues, today’s hospitals face the same supply and demand issues as consumers in need of services, especially in rural communities, where the existence of even one qualified psychiatrist is often lacking. EDs typically have limited or non-existent in-house hospital expertise available to them, and patients must wait until an appropriate professional is available. These present-day realities lead to crowded ED waiting areas, protracted waits, and the common practice of “boarding” individuals in need of psychiatric evaluation.
The Growing Influence of ED Telepsychiatry Models
Overall, hospital executives are prioritizing telemedicine models to prepare for value-based care. The “2017 U.S. Telemedicine Industry Benchmark Survey” revealed that 51 percent of executives rank deployment and adoption of telemedicine high strategically.
On-demand telepsychiatry models are certainly gaining traction as hospital EDs look to more effectively deliver behavioral health care and address the growing need for services. Provided via video-conference, telepsychiatry providers offer on-call professionals that can be accessed based on need. This framework enables telepsychiatrists to deliver care remotely to numerous organizations at once, increasing efficiency and workflows for all stakeholders.
Credentialed telepsychiatrists first collaborate with ED physicians, nurses and social workers, and review a patient’s medical record. An evaluation is then conducted with a patient in a private area through a computer, tablet or other mobile device. Ultimately, the goal of these one-time encounters is to ensure timely recommendations and triage of patients to the most appropriate level of care. On-demand providers provide valuable consultation services to ED staff and can also prescribe medications directly.
Benefits of on-demand telepsychiatry in the ED include:
Early stabilization and better outcomes
Timely psychiatric treatment initiated in the ED promotes earlier stabilization of conditions and improves patient safety—for both those facing a psychiatric crisis and other patients in the ED. It also ensures patients are triaged to the appropriate level of care or community service.
For instance, it is not uncommon for police officers in some states to bring individuals behaving erratically directly to the ED for psychiatric evaluation. Many of these patients do not require inpatient psychiatric hospitalizations, which can be often be avoided by having timely access to psychiatric professionals who can determine the appropriate level of care.
Many telepsychiatrists also report that patients in crisis situations, particularly those who are agitated or paranoid, can feel less intimidated by video conferencing as opposed to in-person evaluation.
Increased patient throughput
When evaluations are conducted in a timely manner, ED providers can help get patients to appropriate levels of care, opening needed beds to other patients and improving wait room crowding.
Greater patient satisfaction
A combination of timely evaluation and the right expertise ensures a better overall experience for any patients in crisis, including those with behavioral health concerns. When patients are forced to wait for hours or days to see a behavioral health professional, frustration is understandable.
Lower costs
Timely access to care lends to greater efficiencies in the ED and positive bottom-line impacts. In addition, telepsychiatry reduces the need for full-time emergency psychiatrists and ongoing recruitment costs and challenges.
Many hospitals—especially those in rural areas—simply lack the financial resources needed to hire specialized behavioral health professionals to provide services the ED. Additionally, hospitals benefit from the on-demand model by paying for usage as opposed to a full-time equivalent. EDs also reduce liabilities with timely access to on-demand telepsychiatry services, minimizing the potential for litigation that might otherwise occur if conditions escalate and difficult situations arise.
Reduced provider burnout
This approach to care also takes the burden off in-person psychiatric providers who are on call or responsible for covering night-shifts. Telepsychiatrists can work these shifts remotely from another location, even in different time zones, offering added flexibility and an enhanced work/life balance—critical components in addressing provider burnout.
Providing a telepsychiatry resource can also reduce stress on ED directors and other ED providers who do not have the specialty training in psychiatry, but are often faced with treating psychiatric patients.
Future Crisis Behavioral Health Models
While the current outlook on behavioral health professional shortages is grim, the good news is that telepsychiatry holds great promise for filling needed gaps, especially in critical environments such as EDs. Hospitals can realize notable gains by leveraging on-demand telepsychiatry services to improve outcomes, patient and provider satisfaction and the bottom line.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.