An Introduction to Telebehavioral HealthJodi Polaha, Ph.D., East Tennessee State University

Overview

PresentationStyle

Dealing with Distance

Setting It UpExample

andResearch

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Setting It Up: Equipment

Provider Site: Teleconferencing

Client site: Teleconferencing

Setting It Up: Equipment

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

Setting It Up: Equipment

Home Health

Setting It Up: Equipment

Monitor-Based PC-Based, “Web Cams”

Polycom, LIfeSize, Tandberg Logitech, Via-Video, ViGO

Videoconferencing

Setting It Up: Equipment

Dedicated Line “T1” Faster/Clearer More stable More secure

Internet “High-Speed”/Cable Cheaper Easier More flexible

Transmission:

Setting It Up: Equipment

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

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Setting It Up: Staff

Provider Site: IT person (on call) Coordinator

Client Site: IT person (on call) Coordinator

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

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

Setting It Up: Staff

Checklist

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Setting It Up: SchedulingPatient/ReferralSource

ClinicianSite

Coordinator

ClinicianPatient

SiteCoordinator

Both“yes”

Either“no”

Confirm Repeat

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

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.

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Presentation Style: Meeting the ClientChecklist

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Presentation Style: Theatrics

Wear blue, or at least, no stripes. Exaggerate nonverbal behavior. Label your “off screen” behavior. “Mute” your microphone when not talking.

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Building Rapport

Cultural and Related Issues

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.

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Building Rapport

Cultural and Related Issues

Dealing with the Distance: Cultural and Related IssuesThe 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?

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.

Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Building Rapport

Cultural and Related Issues

Nebraska Program

Other Research

MMI Behavioral Health Outreach Clinics2006

Gordon BHCEst. 2004 at Gordon Medical Clinic

Chadron BHCEst. 2004 at Chadron Medical Clinic

Columbus BHCEst. 1997 at CCH Pediatric

Kearney BHCEst. 2003 at Kearney Clinic Pediatrics

Hastings BHCEst. 1998 at Children and Adolescent Clinic, P.C

Nebraska City BHCEst. 2004 at Physicians Clinic

Plattsmouth BHCEst. 2000 at UMA Plattsmouth

Crete BHCEst. 2005 at Physician’s Clinic

Omaha-Metro ClinicsPapillion BHC, 2000Eagle Run BHC, 2001Creighton BHC, 2003

Crawford BHCEst. 2004 at Crawford Medical Clinic

Lincoln BHCEst. 2005

Fremont BHCEst. 2005 at Professional Partners

Valley BHCEst. 2003

Nebraska Program

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

Nebraska Program

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

Omaha

Nebraska Program

Omaha

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

Omaha

Nebraska Program: Services Provided

Omaha

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

Nebraska Program: Services Provided Age: M = 8.2 yrs Insurance:45% Medicaid Referral: 75% primary care physicians

20% specialty clinics

5% other

Nebraska Program: Services ProvidedPresenting Complaints:

Disruptive behavior (ODD/ADHD)25 Behavior with MR 9 Toileting 2 Sleep 2 Anxiety/Mood 5 Hair Pulling 1 Feeding Disorder 1

Nebraska Program: OutcomesTeleconference Satisfaction Survey

(Collected for 50% of the sample)

Question Mean Score Standard Deviation

Could see doctor clearly 5.43 .79

Had no trouble hearing doctor 5.29 .95

Able to speak freely and ask questions 5.76 .52

Doctor was able to ask me questions 5.80 .41

Doctor seemed to understand my problem 5.44 .91

I was comfortable with/understood what doctor told me

5.32 1.15

The camera made me embarrassed 1.72 1.27

Telemedicine makes care more accessible 5.86 .38

Telemedicine is as good as face-to-face encounter 5.00 .82

Overall, I am satisfied with telemedicine 5.71 .63

1=disagree; 6=agree

Nebraska Program: OutcomesTeleconference Satisfaction Survey

(Collected for 50% of the sample)

Question Mean Score Standard Deviation

Would prefer telemedicine visit rather than waiting for face-to-face

4.88 1.54

Would have traveled if not used telemedicine 4.76 1.59

Traveling would have cut into my work or school time

4.60 1.86

Traveling would have affected my wages 4.43 2.07

Traveling would have caused other inconveniences

5.00 1.83

Would prefer face-to-face visit rather than telemedicine

3.14 1.72

Nebraska Program: Discussion Movement to more localized/regional model

Omaha

Nebraska Program: Services Provided

Omaha

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

Nebraska Program: Overview

Setting It UpPresentation

StyleDealing with

Distance

Staff

Scheduling

Equipment

Example and

Research

Camera Skills and Set Up

Meeting the Client

Theatrics

Building Rapport

Cultural and Related Issues

Nebraska Program

Other Research

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