Session # B3a
Friday, October 11, 2013
Telehealth Video in Primary Care:
Clinical Consultation and Training
Rachel Zahn, PsyD, LCP, Behavioral Health Provider,
Sub-Director of BH Operations
Karla Torres, PsyD, LCP, Director of Behavioral Health
Collaborative Family Healthcare Association 15th Annual Conference
October 10-12, 2013
Broomfield, Colorado U.S.A.
Faculty Disclosure
We have not had any relevant financial relationships
during the past 12 months.
Disclaimer
• We do not discuss in this presentation any
specifications on telehealth video equipment
or software to use as this is not the focus of
our presentation rather it is the clinical value
and uses for telehealth video in mental
health.
Objectives
• Develop a different approach to providing clinical
consultation and supervision of trainees
• Identify the usefulness of implementing
telehealth video to provide behavioral health
services specific to our clinic
• Identify challenges and limitations of using
telehealth video for behavioral health within
primary care
• Outline methods of supervision to trainees within
the behavioral health consultation model
History of the BH Department
2004
Joined APA accredited consortium
2004-2006
1 psychologist and and 1 pre-doc intern serving all 3 sites
2007
1 psychologist, 1 post-doc resident, 2 pre-doc interns
2010
First use of Telehealth with OB patients
2012
Use of Telehealth for supervision and consultation with other
professionals
2013
• 8 licensed clinicians: 7 which are psychologists, 2 post-doc residents,
1 pre-doc intern
• 5 sites serving over 8,000 patient visits a year
• 5 bilingual psychologists, English/Spanish
• Current ratio approx about 8-10 providers per Behavioral Health
Provider (BHP)
• Populations predominantly low income, uninsured, chronic mental
illness and substance abuse. Culturally diverse with large ratio of
African-American and Latino populations
What it looks like…
Provider
Area
Exam
Rooms
Hallway
Next BHC
F/U
= PCP
= BHC
Diabetes,
Insomnia,
Substance Abuse,
Anxiety, Mood d/o
What BHC Looks •Like
at
LCHC?
Immediate and open access to carePCP is able to make personal referral
to the BH provider.
• Maximize patient time as they wait
• Maximizes PCP efficiency during
patient visit
Telehealth Implementation
• Equipment:
– TV or laptop (with built-in or
camera attached),
microphone/speakers, laptop
cart, cable connection/wifi
• Setup:
– Stationary TV (designated BH
room)
– Mobile laptop cart (able to
move between exam rooms)
Type of Use
• Consultation
– BHP Solo: OB screenings alongside care team
– Side by Side: 1 BHP in room/ 1 BHP on video
(supervising)
– Consultation with PCP and care team
• Training
– Shadowing
– Supervision (live)
EMR facilitates remote access
Research and Experience
• Research:
– Studies have found patients benefit and
are not harmed by telemental health
– Effective for various disorders
(agoraphobia, panic d/o, psychotic)
• Studies compared in-person vs video interviews in
psychotic patients concluded that even those with
delusions pertaining to the TV, responded
appropriately to video and did not incorporate their
experience into their delusional system.
• Experience:
– Anecdotally, patients have responded
positively about their experience noting
no difference whether in-person or on
video, more so noting the benefit of
seeing a BHP during their visit regardless
of method used (formal piloting of
research currently underway)
Tele mental Health: Expanded
• Other Uses
– Training
– Supervision
– Consultation with
professionals across
different sites
• Advantages
– Cost-effective live
supervision v two waymirror
– Flexible, convenient and
versatile
– Remote access supervision
• Limitations to consider
– APA guidelines: not to take
the place of face to face
supervision
– Equipment/technical
troubleshooting
Guidelines for use of
Telemental health
• Use of telehealth video and appropriate protocols
shall be coordinated with the remote health
center in accordance with applicable
jurisdictional law and licensing requirements.
• Practice standards provided by American
Telemedicine Association
• http://www.americantelemed.org/docs/defaultsource/standards/practice-guidelines-for-videobased-online-mental-healthservices.pdf?sfvrsn=6
Resources
www.americantelemed.org
http://www.apapracticecentral.org/update/201
0/08-31/telehealth-resources.aspx
Telemental Health
(Myers & Turvey, 2012)
References
• Sharp IR, Kobak KA, Osman DA. The use of
videoconferencing with patients with psychosis: a review
of the literature. Annals of general psychiatry
2011;10(1):14.
• Dongier M, Tempier R, Lalinec-Michaud M, Meunier D.
Telepsychiatry: psychiatric consultation through two-way
television. A controlled study. Can J Psychiatry.
1986;31(1):32-4.
• Bouchard S, Paquin B, Payeur R, Allard M, Rivard V,
Fournier T, et al. Delivering cognitive-behavior therapy
for panic disorder with agoraphobia in videoconference.
Telemed J E Health. 2004;10(1):13-25.
Learning Assessment
Audience Question & Answer
Session Evaluation
Please complete and return the
evaluation form to the classroom monitor
before leaving this session.
Thank you!