Post on 04-Jan-2016
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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